Cataract is a common complication of uveitis, from the inflammatory process and as a sequela to corticosteroid treatment. It may account for 40% of vision loss and can occur in up to 64% of patients with uveitis. Posterior capsular opacification (PCO) is the most frequent complication following cataract extraction (CE). The objective of this analysis was to determine the incidence of and predictive factors for the development of PCO in uveitis patients.
Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study (SITE) in the US. The primary outcome was development of PCO requiring YAG capsulotomy.
1,855 eyes of 1,370 patients with a median follow-up of 30 months were analyzed. The incidence rate was greatest in patients age <18 (HR 67.87), but there were no significant differences by age or gender. The risk factors include intraocular lens implantation, HR 65.49 vs 14.49, p-value <0.001; cataract surgery performed year 2000 or later, HR 79.07, p<0.0001; Any pre-operative immunosuppressive therapy (68.15, p= 0.05); The protective factors include HLA-B27 positive, HR 49.60, p=0.0044, and posterior/panuveitis vs anterior uveitis HR 47.06 vs 67.32, p-value 0. 0001.
In patients with uveitis, the formation of PCO can impact visual prognosis after CE. This report is a systematic analysis of both risk and protective factors, not previously reported in a large cohort study. It confirms reported increased incidence in younger patients, and the protective effect of posterior and panuveitis classification. We also report on the possible protective effect of HLA-B27 positivity, which accounts for approximately 50% of acute anterior uveitis. Delineating these risk factors will be instructive in perioperative management and patient counselling.