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Clinical Sciences | Journal Club

Characteristics and Visual Outcome of Patients With Retinal Vasculitis

Jennifer H. Ku, MPH; Amro Ali, MD; Eric B. Suhler, MD, MPH; Dongseok Choi, PhD; James T. Rosenbaum, MD
Arch Ophthalmol. 2012;130(10):1261-1266. doi:10.1001/archophthalmol.2012.1596.
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Objective  To examine the characteristics and visual outcome in 207 patients with retinal vasculitis.

Methods  Demographic and visual outcome data were collected retrospectively from the ophthalmologic records of 207 cases (321 affected eyes). Descriptive analysis was performed on all cases and visual outcome analysis was performed for the 114 cases with visual acuity recorded at 2 or more visits. The Kaplan-Meier method and Cox regression were used to examine visual outcome and predictors for prognosis.

Results  Patients in our series had a roughly even distribution of sex, were predominantly non-Hispanic white (77.8%), and had bilateral disease (75.7%). The annualized mean visual acuity change for the 203 eyes (114 patients) with some follow-up was 0.01 logMAR unit per year. Although 75 eyes (36.9%) had 20/25 or better visual acuity at baseline, 33.6% of the remaining eyes experienced visual acuity improvement of at least 2 lines on the Snellen chart during follow-up and some continued to improve more than 9 years after the initial evaluation. Cox multivariate analysis demonstrated that patients who were nonwhite, had worse visual acuity at baseline, or who had an ocular infection were more likely to experience improvement by this definition.

Conclusions  We believe that this is the first US case series to investigate visual outcome in patients with this diagnosis. Although many patients in our series worsened despite therapy, a subset experienced substantial improvement.

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Figures

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Figure 1. Percentage treated and treatment used in 99 patients who had 1 or more visits and did not have ocular infection. *Includes vitrectomy, phacoemulsification, lens implantation, lensectomy, fluocinolone implant, membranectomy, air-fluid exchange, and trabeculectomy. DMARDs indicates disease-modifying antirheumatic drugs; NSAIDs, nonsteroidal anti-inflammatory drugs; and POKI/IVKI, periocular/intravitreal triamcinolone injections.

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Figure 2. Kaplan-Meier curve demonstrating the cumulative proportion of eyes that experienced visual acuity improvement of 2 or more lines on the Snellen chart as a function of follow-up time in 203 eyes in 114 patients with retinal vasculitis who had visual acuity recorded at 2 or more points. Tick marks represent cases lost to follow-up and dotted lines represent 95% confidence intervals for survival proportions.

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Figure 3. Kaplan-Meier curve demonstrating the cumulative proportion of eyes that experienced visual acuity improvement of 2 or more lines on the Snellen chart as a function of follow-up time by race groups. “White” denotes 150 eyes with retinal vasculitis in non-Hispanic white patients and “other races” denotes 43 eyes in patients with retinal vasculitis who are either black, Asian, Hispanic, or multiracial. Ten eyes from patients of unknown race were excluded. Tick marks represent cases lost to follow-up and dotted lines represent 95% confidence intervals for survival proportions.

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Grahic Jump Location

Figure 4. Kaplan-Meier curve demonstrating the cumulative proportion of eyes that experienced visual acuity improvement of 2 or more lines on the Snellen chart as a function of follow-up time by infectious vs noninfectious cause. “Infectious” denotes 20 eyes in patients with retinal vasculitis secondary to an ocular infection and “noninfectious” denotes 183 eyes with retinal vasculitis without an infectious cause. Tick marks represent cases lost to follow-up and dotted lines represent 95% confidence intervals for survival proportions.

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