Exudative Retinal Detachment in Ocular Inflammatory Diseases: Risk and Predictive Factors

Am J Ophthalmol. 2020 Oct:218:279-287. doi: 10.1016/j.ajo.2020.06.019. Epub 2020 Jul 2.

Abstract

Purpose: This study evaluated the risk and risk factors for exudative retinal detachment (ERD) in ocular inflammatory diseases.

Design: Retrospective cohort study.

Methods: Patients with noninfectious ocular inflammation had been followed longitudinally between 1978 and 2007 at 4 US subspecialty uveitis centers. The main outcome measurements were occurrences of ERD and predictive factors.

Results: A total of 176 of 14,612 eyes with ocular inflammation presented with ERD. Among uveitis cases, Vogt-Koyanagi-Harada syndrome (VKH) (odds ratio [OR] = 109), undifferentiated choroiditis (OR = 9.18), sympathetic ophthalmia (OR = 8.43), primary or secondary panuveitis (OR = 7.09), multifocal choroiditis with panuveitis (OR = 4.51), and "other" forms of posterior uveitis (OR = 16.9) were associated with a higher prevalence of ERD. Among the 9,209 uveitic or scleritic eyes initially free of ERD and followed, 137 incident ERD cases were observed over 28,949 eye-years at risk (incidence rate = 0.47% [0.40%-0.56%/eye-year]). VKH (HR = 13.2), sympathetic ophthalmia (HR = 5.82), undifferentiated choroiditis (HR = 6.03), primary or secondary panuveitis (HR = 4.21), and rheumatoid arthritis (HR = 3.30) were significantly associated with incident ERD. A significant dose-response relationship with the prevalence and incidence of ERD were observed for AC cells and vitreous cell activity. African Americans had significantly higher prevalence and incidence of ERD.

Conclusions: Other ocular inflammatory conditions in addition to VKH syndrome and posterior scleritis were associated with increased risk of ERD, indicating that ERD does not necessarily dictate a diagnosis of VKH or posterior scleritis. In addition, the relationship between ERD and inflammatory severity factors implies that inflammation is a key predictive factor associated with developing ERD and requires early and vigorous control.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Choroiditis / epidemiology*
  • Exudates and Transudates
  • Female
  • Fluorescein Angiography
  • Humans
  • Incidence
  • Inflammation / epidemiology
  • Male
  • Middle Aged
  • Ophthalmia, Sympathetic / epidemiology*
  • Prevalence
  • Retinal Detachment / diagnosis
  • Retinal Detachment / epidemiology*
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Uveitis, Posterior / epidemiology*
  • Uveomeningoencephalitic Syndrome / epidemiology*
  • Visual Acuity / physiology