HLA B 27 related uveitis for the first time after cataract surgery:tip of the iceberg?

Poster Details

First Author: S.Ganesh INDIA

Co Author(s):    N. Anagol   V. Kedia   K. Jain   S. Prabhu     

Abstract Details

Purpose:

To evaluate the aetiology of prolonged post operative uveitis following uneventful cataract surgery in a previously normal patient and the occurrence of the HLA B 27 haplotype in patients with persistent post operative uveitis.

Setting:

The study was conducted at the Nethradhama Superspeciality Eye Hospital, Jayanagar, Bangalore, India.

Methods:

A retrospective analysis of patients presenting with prolonged post operative inflammation following cataract surgery was done during the period from October 2010 to December 2011 31 eyes of 23 patients were studied, who had been referred to the Uveitis Department for prolonged post operative inflammation following uneventful cataract surgery. The sex ratio was 12 males to 11 females. The mean age of the patients was 63.2 years. All the patients underwent topical clear corneal phacoemulsification. The surgeries and immediate post operative period were uneventful. Average duration of referral for management to the Uveitis department was 159 days (range 26 – 632 days) after cataract surgery. All the patients had non granulomatous anterior uveitis (NGAU). 3 eyes of two patients also developed diffuse scleritis. A detailed history was elicited to rule out associated auto immune diseases. All the patients underwent HLA B 27 and other investigations were advised as per the clinical evaluation.

Results:

9 of these patients were HLA B27 positive, of which 5 were males and 4 were females. The average age of diagnosis of HLA B27 uveitis in this series was 60.4 years. 2 patients showed signs of sacroilitis on X ray. 5 of the HLA B27 positive patients were referred to the rheumatologist who advised immunosuppressive therapy (55.5%). Three of these patients had severe prolonged inflammation, one patient was diagnosed with psoriatic arthritis, one patient developed severe inflammation with scleritis and secondary glaucoma. Tuberculin skin test was positive in 6 patients and confirmed by T.B. Gold in 3 patients. 3 patients were started on AKT4 as per the advice of the pulmonologist . Most of the patients needed a prolonged course of steroids topically.

Conclusions:

This study has shown that in a significant number of patients (39.1%) the post operative inflammation was related to HLA B27 . A large number of cases needed Immunosuppressive therapy (55.5%). The HLA B 27 associated cases had a more prolonged and aggressive course as compared to the Idiopathic cases. The most important observation in this study was the occurrence of HLA B 27 uveitis in the 6th decade for the first time. Though routine testing is not recommended in all cases, it may be added to our investigations list when evaluating cases of Persistent post operative uveitis. FINANCIAL DISCLOSURE?: No