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.
Bibliographical noteFunding Information:
Funding/Support: Primary support was provided from grants R01 EY014943 and R21 EY026717 (J.H.K.) and 2P30EYEY001583 (University of Pennsylvania), National Eye Institute/National Institutes of Health (Bethesda, MD); Massachusetts Eye and Ear Global Surgery Program (Boston, MA), Sight for Souls (Fort Myers, FL), and Research to Prevent Blindness (New York, NY). The funding organizations had no role in the design or conduction of this research. Financial Disclosures: J.T.R.: Abbvie (consultant), Gilead (consultant), Janssen (consultant), Eyevensys (consultant), UpToDate (consultant), Pfizer (financial support), Novartis (consultant), Roche (consultant), Alcon Research Institute (financial support); G.A.L.-C.: Abbvie (consultant, lecture fees), Allergan (grant support), Mallinckrodt (consultant, grant support), Sanofi (grant support, lecture fees); E.B.S.: Eyevensys (consultant), Santen (consultant), EyeGate (consultant, financial support), Abbvie (consultant, financial support), Clearside (consultant, financial support), EyePoint (consultant, financial support); J.E.T.: Abbvie (consultant); C.S.F.: Aldeyra (consultant, grant support), Allakos (consultant), Bausch & Lomb (consultant, grant support), Eyegate (consultant, grant support, stock), Genentech (consultant), Novartis (consultant, grant support), pSivida (consultant, grant support), Aciont (grant support), Alcon (grant support, lecture fees), Clearside (grant support), Dompé (grant support), Mallinckrodt (grant support, lecture fees), Allergan (lecture fees); J.H.K.: Gilead (consultant—DSMC Chair), Tampa Bay Uveitis Center (consultant), Betaliq (equity owner). The other authors indicate no financial support or conflicts of interest. All authors attest that they meet the current ICMJE criteria for authorship.
© 2021 Elsevier Inc.