Posterior segment inflammation in HLA-B27+ acute anterior uveitis: clinical characteristics

PURPOSE: To examine clinical characteristics of patients who have posterior segment manifestations in HLA-B27-associated acute anterior uveitis. METHODS: Medical records of 114 HLA-B27-positive patients with acute anterior uveitis were reviewed in a retrospective fashion. Criteria for inclusion were the presence of acute anterior uveitis, a positive HLA-B27 antigen, and one of the following findings: vitreous cells =+2; cystoid macular edema; papillitis; vasculitis; or pars plana exudates. Twenty-four patients met the inclusion criteria. RESULTS: Posterior segment manifestations were found in 24 (21.05%) of 114 patients with HLA-B27+ acute anterior uveitis. Eighteen patients had diffuse vitritis (75%), seven had cystoid macular edema (29.1%), and two had papillitis (8.3%). Three patients had more than one finding. The prevalence of associated systemic disease (15 of 24 patients, 62.5%) and hypopyon (6 of 24 patients, 25%) in patients with posterior segment involvement was significantly higher than in the group of patients without posterior segment involvement (systemic disease, 33 of 90, 36.7%, p=0.04, exact chi-quare test; hypopyon, 4 of 90, 4.4%, p=0.006, exact chi-square test). The mean visual acuity at the last visit was 20/30 (range 20/20-20/100). Immunosuppressive therapy (other than corticosteroids) and surgical intervention were not required in the treatment of patients with posterior segment manifestations. CONCLUSION: HLA-B27+ anterior uveitis is associated with posterior segment manifestations. Patients with posterior segment involvement have a significantly higher incidence of associated systemic diseases and hypopyon.