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

Abstract Purpose To evaluate the risk/risk factors for exudative retinal detachment (ERD) in ocular inflammatory diseases. Design Retrospective cohort study. Methods Patients with non-infectious ocular inflammation had been followed longitudinally between 1978-2007 at four US subspecialty uveitis centers. The main outcome measures were ERD occurrence and its predictive factors. Results One hundred seventy-six of 14,612 eyes with ocular inflammation presented with ERD. Among uveitis cases, Vogt-Koyanagi-Harada syndrome (VKH) (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-up, 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 ERD prevalence and incidence was observed for anterior chamber cells and vitreous cell activity. African Americans had significantly higher prevalence and incidence of ERD. Conclusions Other ocular inflammatory conditions besides VKH and posterior scleritis were associated with increased ERD risk, indicating that ERD does not necessarily dictate a diagnosis of VKH or posterior scleritis. In addition, the relationship of ERD with inflammatory severity factors implies that inflammation is a key predictive factor that is associated with developing ERD and requires early and vigorous control.