Complications of anterior uveitis commonly, but not universally, include cataract development, according to the results of a study published in the American Journal of Ophthalmology. Researchers report the incidence as approximately 5.4/100 eye-years and explain that risk factors include higher recent anterior chamber cell-grade (AC), prior ophthalmic surgery, posterior synechiae, elevated intraocular pressure (IOP), and advanced patient age.
Cataract commonly develops in patients with uveitis, possibly due to inflammation within the eye as well as the clouding effect of corticosteroid treatment. However, there is little data about incidence rates and risk factors of cataracts as a complication of anterior uveitis. Thus, the study sought to characterize the incidence and identify risk factors that may guide clinical management and patient counseling.
The Systemic Immunosuppressive Therapy for Eye Disease (SITE) Cohort Study is a retrospective cohort study that evaluated data from 3923 eyes from 2567 patients with anterior uveitis. To evaluate absolute cataract risk (time-to-occurrence of cataract), cataract was defined as a drop in Snellen-equivalent visual acuity to a level worse than 20/40 or occurrence of cataract surgery.
Visually significant cataract developed in 507 (12.9%) of eyes, which equates to an incidence of 0.054 events per eye-year (95% CI, 0.049-0.059). About a quarter of the eyes developed cataract within 3 years. Risk factors associated with cataract development included
- Age older than 65 years (adjusted HR, 5.04; 95% CI, 3.04-8.33)
- Age 45 to 64 years (adjusted HR, 2.22; 95% CI, 1.43-3.44)
- Anterior chamber cell grade worse than 0.5+ at previous appointment (adjusted HR, 2.60; 95% CI, 1.65-4.11)
- Prior incisional glaucoma surgery (adjusted HR, 1.86; 95% CI, 1.10-3.14)
- Presence of band keratopathy at or prior to the visit observed (adjusted HR, 2.23; 95% CI, 1.47-3.37)
- Presence of posterior synechiae at or prior to the visit observed (adjusted HR, 3.71; 95% CI, 2.83-4.87)
- Highly elevated IOP at the preceding visit (defined as >30 vs 6-20 mm Hg [adjusted HR, 2.57; 95% CI, 1.38-4.77])
Factors not associated with cataracts as a complication of anterior uveitis include current or former smoking, statin use, aspirin use, systemic nonsteroidal anti-inflammatory use, or angiotensin converting enzyme inhibitor use, according to the study.
Regarding topical corticosteroid therapy, the study authors state, “The results of this analysis can be interpreted as showing that any dose of topical corticosteroids can be used without increasing cataract risk over and above that resulting from anterior chamber inflammation itself at levels of grade 1+ or higher—perhaps because the negative effects of corticosteroids on the lens are balanced by the beneficial effects on reducing inflammation.”
The study was completed at a tertiary care center, which may cause the incidence of cataracts as a complication of anterior uveitis to be overestimated.
Papaliodis GN, Rosner BA, Dreger KA, et al. Incidence of and risk factors for cataract in anterior uveitis. Am J Ophthalmol. Published online July 4, 2023. doi:10.1016/j.ajo.2023.06.021