Risk of Retinal Neovascularization in Cases of Uveitis

Purpose

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 4 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 of 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 years compared with >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 with 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 with 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 compared with inactive inflammation. Neovascularization 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 nonsignificantly increased NV incidence. Results were similar in sensitivity analyses excluding the small minority of patients with diabetes mellitus.

Conclusions

Retinal NV is a rare complication of uveitis, which occurs more frequently in younger patients, smokers, and those with intermediate/posterior/panuveitis, systemic vasculopathy, retinal vascular disease, or active inflammation. Inflammation and retinal NV likely are linked; additional studies are needed to further elucidate this connection.