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

Purpose: To examine clinical characteristics of patients who have posterior segment manifestations in HLA-B27-associated acute anterior uveitis. Metho ds: Medical records of 114 HLA-B27-positive patients with acute anterior uv eitis were reviewed in a retrospective fashion. Criteria for inclusion were the presence of acute anterior uveitis, a positive HLA-B27 antigen, and on e of the following findings: vitreous cells greater than or equal to+2; cys toid macular edema; papillitis; vasculitis; or pars plana exudates. Twenty- four patients met the inclusion criteria. Results: Posterior segment manife stations were found in 24 (21.05%) of 114 patients with HLA-B27+ acute ante rior uveitis. Eighteen patients had diffuse vitritis (75%), seven had cysto id macular edema (29.1%), and two had papillitis (8.3%). Three patients had more than one finding. The prevalence of associated systemic disease (15 o f 24 patients, 62.5%) and hypopyon (6 of 24 patients, 25%) in patients with posterior segment involvement was significantly higher than in the group o f patients without posterior segment involvement (systemic disease, 33 of 9 0, 36.7%, p=0.04, exact chi-square 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 uveiti s is associated with posterior segment manifestations. Patients with poster ior segment involvement have a significantly higher incidence of associated systemic diseases and hypopyon.