Incidence of and Risk Factors for Cataract in Anterior Uveitis.
Incidence of and Risk Factors for Cataract in Anterior Uveitis.
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前葡萄膜炎白内障的发病率和危险因素。
DOI：
10.1016/j.ajo.2023.06.021
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发表时间：
2023
影响因子：
4.2
通讯作者：
Thorne,Jennifer
中科院分区：
文献类型：
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作者：
Papaliodis,GeorgeN;Rosner,BernardA;Dreger,KurtA;Fitzgerald,TonettaD;Artornsombudh,Pichaporn;Kothari,Srishti;Gangaputra,SapnaS;Levy-Clarke,GraceA;Nussenblatt,RobertB;Rosenbaum,JamesT;Sen,HNida;Suhler,EricB;Thorne,Jennifer
目的估计非感染性前葡萄膜炎中白内障的发病率/危险因素。设计回顾性多中心队列研究（美国 6 个三级葡萄膜炎地点，1978-2010）。方法由训练有素的专家评审员使用协议驱动的专家图表评审来收集数据。我们研究了白内障的发病率——由于白内障导致的新近视力下降低于 20/40；或意外白内障手术——2567 名前葡萄膜炎患者的 3923 只眼睛。结果 507 只眼睛出现白内障（54/1000 眼年，95% CI 49-59）。与白内障相关的随时间更新的危险因素包括年龄较大（≥65岁与<18岁：调整后的风险比[aHR] 5.04，95% CI 3.04-8.33）、较高的前房细胞等级（P（趋势）= 0.001）、既往青光眼切开手术（aHR 1.86，95% CI 1.10-3.14）、带状角膜病（aHR） 2.23，95% CI 1.47-3.37）、后粘连（aHR 3.71，95% CI 2.83-4.87）和眼压升高≥30 vs 6-20 mm Hg（aHR 2.57，95% CI 1.38-4.77）。原发性急性（aHR 0.59，95% CI 0.30-1.15）和复发性急性（aHR 0.74，95% CI 0.55-0.98）的白内障风险低于慢性前葡萄膜炎。较高剂量的醋酸泼尼松龙 1% 当量使用（≥2 滴/天）与前房细胞等级 0.5+ 或更低的眼睛中白内障风险增加 2 倍以上相关，但与前房细胞等级 1+ 或更高的情况下白内障风险升高无关。 结论 白内障在约 5.4/100 眼年中使前葡萄膜炎复杂化。确定了几个固定和可改变的风险因素，产生了指导白内障风险最小化的积分系统。仅当前房细胞不存在或极少存在时，局部皮质类固醇才会与白内障风险增加相关，这表明使用它们来治疗活动性炎症（其本身会导致白内障）不会导致白内障发病率的净增加。
PURPOSETo estimate the incidence/risk factors for cataract in noninfectious anterior uveitis.DESIGNRetrospective multicenter cohort study (6 US tertiary uveitis sites, 1978-2010).METHODSData were harvested by trained expert reviewers, using protocol-driven review of experts’ charts. We studied cataract incidence—newly reduced visual acuity worse than 20/40 attributed to cataract; or incident cataract surgery—in 3923 eyes of 2567 patients with anterior uveitis.RESULTSCataract developed in 507 eyes (54/1000 eye-years, 95% CI 49-59). Time-updated risk factors associated with cataract included older age (≥65 vs <18 years: adjusted hazard ratio [aHR] 5.04, 95% CI 3.04-8.33), higher anterior chamber cell grade (P(trend)=0.001), prior incisional glaucoma surgery (aHR 1.86, 95% CI 1.10-3.14), band keratopathy (aHR 2.23, 95% CI 1.47-3.37), posterior synechiae (aHR 3.71, 95% CI 2.83-4.87), and elevated intraocular pressure ≥30 vs 6-20 mm Hg (aHR 2.57, 95% CI 1.38-4.77). Primary acute (aHR 0.59, 95% CI 0.30-1.15) and recurrent acute (aHR 0.74, 95% CI 0.55-0.98) had lower cataract risk than chronic anterior uveitis. Higher-dose prednisolone acetate 1%-equivalent use (≥2 drops/day) was associated with >2-fold higher cataract risk in eyes with anterior chamber cell grades 0.5+ or lower but was not associated with higher cataract risk in the presence of anterior chamber cells of grade 1+ or higher.CONCLUSIONSCataract complicates anterior uveitis in ∼5.4/100 eye-years. Several fixed and modifiable risk factors were identified, yielding a point system to guide cataract risk minimization. Topical corticosteroids only were associated with increased cataract risk when anterior chamber cells were absent or minimally present, suggesting their use to treat active inflammation (which itself is cataractogenic) does not cause a net increase in cataract incidence.