Risk of Retinal Neovascularization in Cases of Uveitis

Abstract

Objective To evaluate the risk of and risk factors for retinal neovascularization (NV) in cases of uveitis. Design Retrospective cohort study. Participants Patients with uveitis at four US academic ocular inflammation subspecialty practices. Methods Data were ascertained by standardized chart review. Prevalence data analysis used logistic regression. Incidence data analysis used survival analysis with time-updated covariates where appropriate. Main Outcome Measures Prevalence and incidence of NV. Results Among uveitic eyes of 8931 patients presenting for initial evaluation, 106/13,810 eyes had NV (prevalence=0.77%, 95% confidence interval (CI): 0.60%–0.90%). Eighty-eight more eyes developed NV over 26,465 eye-years (incidence=0.33%/eye-year, 95% CI: 0.27–0.41%). Factors associated with incident NV include age <35 as compared to >35 years (adjusted hazard ratio (aHR) = 2.4, 95% CI: 1.5–3.9), current cigarette smoking (aHR=1.9, 95% CI: 1.1–3.4), and systemic lupus erythematosus (aHR=3.5, 95% CI: 1.1–11). Recent diagnosis of uveitis was associated with an increased incidence of NV (compared to patients diagnosed >5 years ago, aHR=2.4 (95% CI 1.1–5.0) and aHR=2.6 (95%CI 1.2–6.0) for diagnosis within <1 year vs. 1–5 years respectively). Compared to anterior uveitis, intermediate uveitis (aHR=3.1, 95% CI: 1.5–6.6), posterior uveitis (aHR=5.2, 95% CI: 2.5–11), and panuveitis (aHR=4.3, 95% CI: 2.0–9.3) were associated with a similar degree of increased NV incidence. Active (aHR=2.1, 95%CI: 1.2–3.7) and slightly active (aHR=2.4, 95%CI: 1.3–4.4) inflammation were associated with an increased incidence of NV as compared to inactive inflammation. NV incidence also was increased with retinal vascular occlusions (aHR=10, 95% CI: 3.0–33), retinal vascular sheathing (aHR=2.6, 95% CI: 1.4–4.9), and exudative retinal detachment (aHR=4.1, 95% CI: 1.3–13). Diabetes mellitus was associated with a somewhat increased incidence of retinal NV (aHR=2.3, 95% CI: 1.1–4.9); and systemic hypertension (aHR 1.5; 95% CI:0.89–2.4) was associated with non-significantly increased NV incidence. Results were similar in sensitivity analyses excluding the small minority of patients with diabetes mellitus. Conclusions Retinal neovascularization is a rare complication of uveitis, which occurs more frequently in younger patients; smokers; and those with intermediate/posterior/panuveitis, systemic vasculopathy and/or retinal vascular disease; and active inflammation. Inflammation and retinal neovascularization likely are linked; additional studies are needed to further elucidate this connection.

Retinal neovascularization and its regression on doxycycline in epidemic retinitis

“…in their largest case series of epidemic retinitis described only 3 cases developing rNV. [ 1 ] Inflammation is a key factor in the development of rNV in uveitis[ 2 3 ] and multiple reports have stated the regression of rNV by corticosteroids. [ 3 ] The resolution of retinal neovascularization with doxycycline in our case might be due to its antiinflammatory property[ 4 ] or the suppression of antivascular endothelial growth factor.…”

Intermediate Uveitis

“…Retinal ischemia leads to peripheral retinal neovascularization and occasionally neovascularization of the optic nerve [106,117]; no choroidal neovascularization was found in intermediate uveitis patients in a large cohort study [118]. Incident retinal neovascularization occurs 3 times more commonly in intermediate than in anterior uveitis [119]. Wide-angle OCT angiography has documented ischemia in the choriocapillaris, choroid, and deep capillary plexus in pars planitis [116].…”

Optical coherence tomography angiography in uveitis

“…Retinal NV may develop in uveitic patients through inflammatory and ischemic mechanisms. It is frequently seen in Behçet's disease (ABD), sarcoidosis, pars planitis, Eales disease, tuberculosis, systemic lupus erythematosus (SLE), and idiopathic retinal vasculitis [103,104].…”