Patients with acute anterior uveitis prone to ipsilateral recurrence

Recurrence in the ipsilateral eye is not uncommon in nearly half of patients with acute anterior uveitis (AAU), while one in four may experience recurrence in the contralateral eye, suggests a study.

In addition, patients with viral disease appear to be at greatest risk of ipsilateral recurrence but have the lowest risk of contralateral recurrence.

This retrospective cohort study was conducted in a single tertiary ophthalmic clinical centre. AAU patients were identified using a database of Inflammatory Eye Disease presenting to Te Whatu Ora in Auckland, New Zealand, between 2008 and 2021.

Researchers gathered data retrospectively from chart review and electronic patient records. They reported the recurrence rates using the Kaplan–Meier estimator and identified the risk factors using a marginal Cox regression model.

Overall, 2,763 eyes from 2,092 patients with AAU were included in the analysis, with a median follow-up period of 8.9 years. Ipsilateral recurrence occurred in 1,258 eyes (45.5 percent) and contralateral recurrence in 522 eyes (27.3 percent).

At 10 years, the rates of ipsilateral recurrence were 38.1 percent for idiopathic disease, 43.2 percent for human leukocyte antigen B27 (HLA-B27)/inflammatory arthritis, and 44.9 percent for viral uveitis.

Multivariate analysis revealed the following factors associated with increased risk of ipsilateral recurrence: older age (p<0.001), Maori ethnicity (p=0.006), Asian ethnicity (p<0.001), HLA-B27/inflammatory arthritis (p<0.001), and viral uveitis (p=0.018). No association was found for gender, smoking, bilaterial disease, or hypertensive uveitis.

On the other hand, recurrence in the contralateral eye was significantly lower than in the ipsilateral eye. At 10 years, contralateral recurrence rates were 15.2 percent for idiopathic uveitis, 37.6 percent for HLA-B27/inflammatory arthritis, and 2.0 percent for viral uveitis.

Factors associated with increased risk of contralateral recurrence included Maori ethnicity (p=0.003), Pasifika (Pacific Islanders) ethnicity (p=0.021), and HLA-B27/inflammatory arthritis (p<0.001).

At final follow-up, 411 eyes (14.9 percent) had moderate vision loss, which was associated with shorter time to first recurrence (p<0.001).

“Patients with risk factors for recurrence should be managed and counselled appropriately to minimize the risk of visual loss and complications of uveitis,” the researchers said.