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. 2021 Sep:229:200-209.
doi: 10.1016/j.ajo.2021.02.032. Epub 2021 Mar 10.

Risk of Cataract in Intermediate Uveitis

Caroline L Minkus  1 , Maxwell Pistilli  2 , Kurt A Dreger  3 , Tonetta D Fitzgerald  2 , Abhishek R Payal  4 , Hosne Begum  5 , R Oktay Kaçmaz  6 , Douglas A Jabs  7 , Robert B Nussenblatt  8 , James T Rosenbaum  9 , Grace A Levy-Clarke  10 , H Nida Sen  8 , Eric B Suhler  11 , Jennifer E Thorne  7 , Nirali P Bhatt  2 , C Stephen Foster  12 , Jeanine M Buchanich  13 , John H Kempen  14 ; Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study Research Group
Affiliations

Risk of Cataract in Intermediate Uveitis

Caroline L Minkus et al. Am J Ophthalmol. 2021 Sep.

Abstract

Purpose: To determine the incidence of and predictive factors for cataract in intermediate uveitis.

Design: Retrospective cohort study.

Methods: Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study, in which medical records were reviewed to determine demographic and clinical data of every eye/patient at every visit at 5 participating US tertiary care uveitis centers. The primary outcome was development of vision-compromising cataract as defined by a decrease in visual acuity to 20/40 or less, or requiring cataract surgery. Survival analysis assessed visually defined cataract to avoid bias due to timing of surgery vis-à-vis inflammatory status.

Results: Among 2,190 eyes of 1,302 patients with intermediate uveitis, the cumulative incidence of cataract formation was 7.6% by 1 year (95% confidence interval [CI] = 6.2%-9.1%), increasing to 36.6% by 10 years (95% CI = 31.2%-41.6%). Increased cataract risk was observed in eyes with concurrent anterior uveitis causing posterior synechiae (hazard ratio = 2.68, 95% CI = 2.00-3.59, P < .001), and in eyes with epiretinal membrane formation (hazard ratio = 1.54, 95% CI = 1.15-2.07, P = .004). Higher dose corticosteroid therapy was associated with significantly higher incidence of cataract, especially time-updated use of topical corticosteroids ≥2 times/d or ≥4 periocular corticosteroid injections. Low-dose corticosteroid medications (oral prednisone 7.5 mg daily or less, or topical corticosteroid drops <2 times/d) were not associated with increased cataract risk.

Conclusions: Our study found that the incidence of clinically important cataract in intermediate uveitis is moderate. The risk is higher with markers of severity and with higher doses of corticosteroid medications, the latter being potentially modifiable.

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Figures

Figure 1.
Figure 1.
Kaplan Meier curve depicting the cumulative incidence of cataract formation (reduced visual acuity to worse than 20/40 attributed to cataract or occurrence of cataract surgery), with 95% confidence interval, among eyes of patients with intermediate uveitis, Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study
Figure 2.
Figure 2.
Kaplan Meier curve of incidence of cataract (reduced visual acuity to worse than 20/40 attributed to cataract or occurrence of cataract surgery) in eyes with and without presence of posterior synechiae (time-updated, once present always present), eyes of patients with intermediate uveitis, Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study
Figure 3.
Figure 3.
Kaplan Meier curve of incidence of cataract (reduced visual acuity to worse than 20/40 attributed to cataract or occurrence of cataract surgery) in eyes treated and not treated with topical corticosteroids (time-updated), eyes of patients with intermediate uveitis, Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study
Figure 4.
Figure 4.
Kaplan Meier curve of incidence of cataract formation in eyes treated and not treated with periocular corticosteroid injections (time-updated cumulative number of injections), eyes of patients with intermediate uveitis, Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study
See this image and copyright information in PMC

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