Hypopyon in Patients with Uveitis

Ali A. Zaidi, Gui Shuang Ying, Ebenezer Daniel, Sapna Gangaputra, James (Jim) Rosenbaum, Eric Suhler, Jennifer E. Thorne, C. Stephen Foster, Douglas A. Jabs, Grace A. Levy-Clarke, Robert B. Nussenblatt, John H. Kempen

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Abstract

Purpose: To evaluate the risk of and risk factors for hypopyon among patients with uveitis and to evaluate the risk of visual changes and complications after hypopyon. Design: Retrospective cohort study. Participants: Patients with uveitis at 4 academic ocular inflammation subspecialty practices. Methods: Data were ascertained by standardized chart review. Main Outcome Measures: Prevalence and incidence of hypopyon, risk factors for hypopyon, and incidence of visual acuity changes and ocular complications after hypopyon. Results: Among 4911 patients with uveitis, 41 (8.3/1000) cases of hypopyon were identified at the time of cohort entry. Of these, 2885 initially free of hypopyon were followed over 9451 person-years, during which 81 patients (2.8%) developed hypopyon (8.57/1000 person-years). Risk factors for incident hypopyon included Behçet's disease (adjusted relative risk [RR]=5.30; 95% confidence interval [CI], 2.76-10.2), spondyloarthropathy (adjusted RR=2.86; 95% CI, 1.48-5.52), and human leukocyte antigen (HLA)-B27 positivity (adjusted RR=2.04; 95% CI, 1.17-3.56). Patients with both a spondyloarthropathy and HLA-B27 had a higher risk than either factor alone (crude RR=4.39; 95% CI, 2.26-8.51). Diagnosis of intermediate uveitis (± anterior uveitis) was associated with a lower risk of hypopyon (with respect to anterior uveitis only, adjusted RR=0.35; 95% CI, 0.15-0.85). Hypopyon incidence tended to be lower among patients with sarcoidosis (crude RR=0.22; 95% CI, 0.06-0.90; adjusted RR=-0.28; 95% CI, 0.07-1.15). Post-hypopyon eyes and eyes not developing hypopyon had a similar incidence of band keratopathy, posterior synechiae, ocular hypertension, hypotony, macular edema, epiretinal membrane, cataract surgery, or glaucoma surgery. Post-hypopyon eyes were more likely than eyes not developing hypopyon to gain 3 lines of vision (crude RR=1.54; 95% CI, 1.05-2.24) and were less likely to develop 20/200 or worse visual acuity (crude RR=0.41; 95% CI, 0.17-0.99); otherwise, visual outcomes were similar in these groups. Conclusions: Hypopyon is an uncommon occurrence in patients with uveitis. Risk factors included Behçet's disease, HLA-B27 positivity, and spondyloarthropathy. Intermediate uveitis cases (± anterior uveitis) had a lower risk of hypopyon. On average, post-hypopyon eyes were no more likely than other eyes with uveitis to develop structural ocular complications or lose visual acuity. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Original languageEnglish (US)
Pages (from-to)366-372
Number of pages7
JournalOphthalmology
Volume117
Issue number2
DOIs
StatePublished - Feb 2010

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Uveitis
Confidence Intervals
Anterior Uveitis
Spondylarthropathies
Intermediate Uveitis
HLA Antigens
Visual Acuity
Incidence
Disclosure
Ocular Hypotension
Epiretinal Membrane
Ocular Hypertension
Macular Edema
Sarcoidosis
Glaucoma
Cataract
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

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Zaidi, A. A., Ying, G. S., Daniel, E., Gangaputra, S., Rosenbaum, J. J., Suhler, E., ... Kempen, J. H. (2010). Hypopyon in Patients with Uveitis. Ophthalmology, 117(2), 366-372. https://doi.org/10.1016/j.ophtha.2009.07.025

Hypopyon in Patients with Uveitis. / Zaidi, Ali A.; Ying, Gui Shuang; Daniel, Ebenezer; Gangaputra, Sapna; Rosenbaum, James (Jim); Suhler, Eric; Thorne, Jennifer E.; Foster, C. Stephen; Jabs, Douglas A.; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Kempen, John H.

In: Ophthalmology, Vol. 117, No. 2, 02.2010, p. 366-372.

Research output: Contribution to journalArticle

Zaidi, AA, Ying, GS, Daniel, E, Gangaputra, S, Rosenbaum, JJ, Suhler, E, Thorne, JE, Foster, CS, Jabs, DA, Levy-Clarke, GA, Nussenblatt, RB & Kempen, JH 2010, 'Hypopyon in Patients with Uveitis', Ophthalmology, vol. 117, no. 2, pp. 366-372. https://doi.org/10.1016/j.ophtha.2009.07.025
Zaidi AA, Ying GS, Daniel E, Gangaputra S, Rosenbaum JJ, Suhler E et al. Hypopyon in Patients with Uveitis. Ophthalmology. 2010 Feb;117(2):366-372. https://doi.org/10.1016/j.ophtha.2009.07.025
Zaidi, Ali A. ; Ying, Gui Shuang ; Daniel, Ebenezer ; Gangaputra, Sapna ; Rosenbaum, James (Jim) ; Suhler, Eric ; Thorne, Jennifer E. ; Foster, C. Stephen ; Jabs, Douglas A. ; Levy-Clarke, Grace A. ; Nussenblatt, Robert B. ; Kempen, John H. / Hypopyon in Patients with Uveitis. In: Ophthalmology. 2010 ; Vol. 117, No. 2. pp. 366-372.
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abstract = "Purpose: To evaluate the risk of and risk factors for hypopyon among patients with uveitis and to evaluate the risk of visual changes and complications after hypopyon. Design: Retrospective cohort study. Participants: Patients with uveitis at 4 academic ocular inflammation subspecialty practices. Methods: Data were ascertained by standardized chart review. Main Outcome Measures: Prevalence and incidence of hypopyon, risk factors for hypopyon, and incidence of visual acuity changes and ocular complications after hypopyon. Results: Among 4911 patients with uveitis, 41 (8.3/1000) cases of hypopyon were identified at the time of cohort entry. Of these, 2885 initially free of hypopyon were followed over 9451 person-years, during which 81 patients (2.8{\%}) developed hypopyon (8.57/1000 person-years). Risk factors for incident hypopyon included Beh{\cc}et's disease (adjusted relative risk [RR]=5.30; 95{\%} confidence interval [CI], 2.76-10.2), spondyloarthropathy (adjusted RR=2.86; 95{\%} CI, 1.48-5.52), and human leukocyte antigen (HLA)-B27 positivity (adjusted RR=2.04; 95{\%} CI, 1.17-3.56). Patients with both a spondyloarthropathy and HLA-B27 had a higher risk than either factor alone (crude RR=4.39; 95{\%} CI, 2.26-8.51). Diagnosis of intermediate uveitis (± anterior uveitis) was associated with a lower risk of hypopyon (with respect to anterior uveitis only, adjusted RR=0.35; 95{\%} CI, 0.15-0.85). Hypopyon incidence tended to be lower among patients with sarcoidosis (crude RR=0.22; 95{\%} CI, 0.06-0.90; adjusted RR=-0.28; 95{\%} CI, 0.07-1.15). Post-hypopyon eyes and eyes not developing hypopyon had a similar incidence of band keratopathy, posterior synechiae, ocular hypertension, hypotony, macular edema, epiretinal membrane, cataract surgery, or glaucoma surgery. Post-hypopyon eyes were more likely than eyes not developing hypopyon to gain 3 lines of vision (crude RR=1.54; 95{\%} CI, 1.05-2.24) and were less likely to develop 20/200 or worse visual acuity (crude RR=0.41; 95{\%} CI, 0.17-0.99); otherwise, visual outcomes were similar in these groups. Conclusions: Hypopyon is an uncommon occurrence in patients with uveitis. Risk factors included Beh{\cc}et's disease, HLA-B27 positivity, and spondyloarthropathy. Intermediate uveitis cases (± anterior uveitis) had a lower risk of hypopyon. On average, post-hypopyon eyes were no more likely than other eyes with uveitis to develop structural ocular complications or lose visual acuity. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.",
author = "Zaidi, {Ali A.} and Ying, {Gui Shuang} and Ebenezer Daniel and Sapna Gangaputra and Rosenbaum, {James (Jim)} and Eric Suhler and Thorne, {Jennifer E.} and Foster, {C. Stephen} and Jabs, {Douglas A.} and Levy-Clarke, {Grace A.} and Nussenblatt, {Robert B.} and Kempen, {John H.}",
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TY - JOUR

T1 - Hypopyon in Patients with Uveitis

AU - Zaidi, Ali A.

AU - Ying, Gui Shuang

AU - Daniel, Ebenezer

AU - Gangaputra, Sapna

AU - Rosenbaum, James (Jim)

AU - Suhler, Eric

AU - Thorne, Jennifer E.

AU - Foster, C. Stephen

AU - Jabs, Douglas A.

AU - Levy-Clarke, Grace A.

AU - Nussenblatt, Robert B.

AU - Kempen, John H.

PY - 2010/2

Y1 - 2010/2

N2 - Purpose: To evaluate the risk of and risk factors for hypopyon among patients with uveitis and to evaluate the risk of visual changes and complications after hypopyon. Design: Retrospective cohort study. Participants: Patients with uveitis at 4 academic ocular inflammation subspecialty practices. Methods: Data were ascertained by standardized chart review. Main Outcome Measures: Prevalence and incidence of hypopyon, risk factors for hypopyon, and incidence of visual acuity changes and ocular complications after hypopyon. Results: Among 4911 patients with uveitis, 41 (8.3/1000) cases of hypopyon were identified at the time of cohort entry. Of these, 2885 initially free of hypopyon were followed over 9451 person-years, during which 81 patients (2.8%) developed hypopyon (8.57/1000 person-years). Risk factors for incident hypopyon included Behçet's disease (adjusted relative risk [RR]=5.30; 95% confidence interval [CI], 2.76-10.2), spondyloarthropathy (adjusted RR=2.86; 95% CI, 1.48-5.52), and human leukocyte antigen (HLA)-B27 positivity (adjusted RR=2.04; 95% CI, 1.17-3.56). Patients with both a spondyloarthropathy and HLA-B27 had a higher risk than either factor alone (crude RR=4.39; 95% CI, 2.26-8.51). Diagnosis of intermediate uveitis (± anterior uveitis) was associated with a lower risk of hypopyon (with respect to anterior uveitis only, adjusted RR=0.35; 95% CI, 0.15-0.85). Hypopyon incidence tended to be lower among patients with sarcoidosis (crude RR=0.22; 95% CI, 0.06-0.90; adjusted RR=-0.28; 95% CI, 0.07-1.15). Post-hypopyon eyes and eyes not developing hypopyon had a similar incidence of band keratopathy, posterior synechiae, ocular hypertension, hypotony, macular edema, epiretinal membrane, cataract surgery, or glaucoma surgery. Post-hypopyon eyes were more likely than eyes not developing hypopyon to gain 3 lines of vision (crude RR=1.54; 95% CI, 1.05-2.24) and were less likely to develop 20/200 or worse visual acuity (crude RR=0.41; 95% CI, 0.17-0.99); otherwise, visual outcomes were similar in these groups. Conclusions: Hypopyon is an uncommon occurrence in patients with uveitis. Risk factors included Behçet's disease, HLA-B27 positivity, and spondyloarthropathy. Intermediate uveitis cases (± anterior uveitis) had a lower risk of hypopyon. On average, post-hypopyon eyes were no more likely than other eyes with uveitis to develop structural ocular complications or lose visual acuity. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

AB - Purpose: To evaluate the risk of and risk factors for hypopyon among patients with uveitis and to evaluate the risk of visual changes and complications after hypopyon. Design: Retrospective cohort study. Participants: Patients with uveitis at 4 academic ocular inflammation subspecialty practices. Methods: Data were ascertained by standardized chart review. Main Outcome Measures: Prevalence and incidence of hypopyon, risk factors for hypopyon, and incidence of visual acuity changes and ocular complications after hypopyon. Results: Among 4911 patients with uveitis, 41 (8.3/1000) cases of hypopyon were identified at the time of cohort entry. Of these, 2885 initially free of hypopyon were followed over 9451 person-years, during which 81 patients (2.8%) developed hypopyon (8.57/1000 person-years). Risk factors for incident hypopyon included Behçet's disease (adjusted relative risk [RR]=5.30; 95% confidence interval [CI], 2.76-10.2), spondyloarthropathy (adjusted RR=2.86; 95% CI, 1.48-5.52), and human leukocyte antigen (HLA)-B27 positivity (adjusted RR=2.04; 95% CI, 1.17-3.56). Patients with both a spondyloarthropathy and HLA-B27 had a higher risk than either factor alone (crude RR=4.39; 95% CI, 2.26-8.51). Diagnosis of intermediate uveitis (± anterior uveitis) was associated with a lower risk of hypopyon (with respect to anterior uveitis only, adjusted RR=0.35; 95% CI, 0.15-0.85). Hypopyon incidence tended to be lower among patients with sarcoidosis (crude RR=0.22; 95% CI, 0.06-0.90; adjusted RR=-0.28; 95% CI, 0.07-1.15). Post-hypopyon eyes and eyes not developing hypopyon had a similar incidence of band keratopathy, posterior synechiae, ocular hypertension, hypotony, macular edema, epiretinal membrane, cataract surgery, or glaucoma surgery. Post-hypopyon eyes were more likely than eyes not developing hypopyon to gain 3 lines of vision (crude RR=1.54; 95% CI, 1.05-2.24) and were less likely to develop 20/200 or worse visual acuity (crude RR=0.41; 95% CI, 0.17-0.99); otherwise, visual outcomes were similar in these groups. Conclusions: Hypopyon is an uncommon occurrence in patients with uveitis. Risk factors included Behçet's disease, HLA-B27 positivity, and spondyloarthropathy. Intermediate uveitis cases (± anterior uveitis) had a lower risk of hypopyon. On average, post-hypopyon eyes were no more likely than other eyes with uveitis to develop structural ocular complications or lose visual acuity. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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