Clinical characteristics of non-infectious uveitis treated with and without systemic immunomodulatory therapy

Tina Felfeli; Arshia Eshtiaghi; Jess Rhee; Michael Balas; Felicia Tai; Alexander J Kaplan; Panos G Christakis; Kira Dzulynsky; Hayley Monson; Efrem D Mandelcorn; Laurence A Rubin; Nupura K Bakshi; Larissa A Derzko-Dzulynsky

doi:10.1016/j.jcjo.2023.10.002

Clinical characteristics of non-infectious uveitis treated with and without systemic immunomodulatory therapy

Can J Ophthalmol. 2023 Nov 13:S0008-4182(23)00308-3. doi: 10.1016/j.jcjo.2023.10.002. Online ahead of print.

Authors

Affiliations

¹ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON. Electronic address: tina.felfeli@mail.utoronto.ca.
² Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON.
³ Faculty of Medicine, Schulich School of Medicine and Dentistry, London, ON.
⁴ Temerty Faculty of Medicine, University of Toronto, Toronto, ON.
⁵ Division of Ophthalmology, McMaster University, Hamilton, ON.
⁶ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON.
⁷ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON.
⁸ Faculty of Engineering, McGill University, Montreal, Que.
⁹ Faculty of Mathematics, McMaster University, Hamilton, ON.
¹⁰ Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Division of Rheumatology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON.
¹¹ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON; Department of Ophthalmology, Mount Sinai Hospital, Toronto, ON.
¹² Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON.

PMID: 37972648
DOI: 10.1016/j.jcjo.2023.10.002

Abstract

Objective: To compare the patient characteristics and long-term outcomes for those treated with and without systemic immunomodulatory therapy (IMT) for non-infectious uveitis (NIU).

Design: Retrospective cohort study.

Participants: All consecutive adults with NIU receiving care at 5 uveitis subspecialty tertiary care clinics between 2010 and 2021.

Methods: Clinical outcomes were evaluated on initial presentation and at the last available follow-up. The main outcome measures were baseline characteristics and final visual acuity.

Results: A total of 914 NIU patients (418 IMT, 496 non-IMT) with a median age of 51.0 years and 57.4% female were identified. Over half the patients had bilateral disease, with a significantly higher proportion of bilateral cases in the IMT group compared with the non-IMT group (p < 0.001). The IMT group was more likely to have chronic uveitis (p < 0.001), with a higher proportion of patients experiencing cataracts and cystoid macular edema (p < 0.001 for both). A significantly higher proportion of non-IMT patients had anterior uveitis and an idiopathic etiology (p < 0.001). Overall, visual acuity improved significantly from baseline to last follow-up in the entire cohort (p < 0.001), with a slightly better improvement in the IMT group. Multivariable linear regression analysis suggested that baseline visual acuity and panuveitis were significant predictors of final visual acuity (p < 0.001 for both).

Conclusions: NIU patients on IMT are often younger, suffer from bilateral and chronic uveitis, and are more likely to have ocular complications. Those in the non-IMT group are more likely to have anterior idiopathic NIU. Baseline visual acuity and panuveitis are the main predictors of final vision outcomes among patients with NIU.