Date

May 2011

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Specific Aims: This retrospective chart review study of 1,307 uveitis patients was undertaken to examine: (1) the proportion of retinal vasculitis patients in specific subsets of uveitis patients; (2) the characteristics of the identified retinal vasculitis cases and; (3) visual outcome of the identified retinal vasculitis cases and predictors for the outcome. Methods: Ophthalmological records of a sample of 1,307 uveitis patients identified from databases at Oregon Health & Science University (OHSU) with at least one visit to the Uveitis clinic at the Casey Eye Institute between August 1985 and December 2008 were reviewed to identify patients with retinal vasculitis. The sample represents approximately 95% of all uveitis patients seen in the Uveitis clinic between August 1985 to present date, and includes 1,237 patients with uveitis with a presumed diagnosis and a subset of 70 patients from 677 patients with uveitis with unclassifiable disease association. Uveitis diagnoses represented by ten or fewer patients were only included when the entity was known to be strongly associated with retinal vasculitis. Demographic and clinical data, including visual outcomes, were collected from the retinal vasculitis patients identified from the sample of 1,307 patients and 34 patients with primary retinal vasculitis. Other covariates were examined to ascertain whether they were predictive of visual acuity outcome improvement of the retinal vasculitis patients Results: Retinal vasculitis was identified in 11.0% of 1,307 studied uveitis patients. Extrapolating the proportion of retinal vasculitis in idiopathic uveitis patients from which only a subset was reviewed, it is presumed that retinal vasculitis may occur in 14.2% of our tertiary referral uveitis patient population. Only 21.2% of these cases had an identifiable systemic-immune mediated disease. Bilateral cases and patients with retinal vasculitis associated with an underlying systemic disease had a better visual outcome than unilateral cases and those affected by primary retinal vasculitis. After adjusting for within-individual correlation and potential confounders, gender, baseline vision, and etiologic sub-groups were associated with improved likelihood of visual acuity improvement. Conclusion: Our study is one of the first U.S. studies to examine the association between retinal vasculitis and a variety of uveitis disease subsets in a tertiary referral population, and the first attempt to investigate visual outcome in retinal vasculitis patients. Our findings on frequency of retinal vasculitis identified in association with specific diagnostic subsets of uveitis are novel. Our findings support the observation that retinal vasculitis occurs in diseases not classically classified as systemic vasculitides, and occurs rather rarely in association with classic forms of systemic vasculitides. Patient demographics were mostly consistent with previously published studies on retinal vasculitis. New findings regarding visual outcomes of the identified retinal vasculitis patients are discussed.

Identifier

doi:10.6083/M4RJ4GF9

School

School of Medicine

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