New research published in the American Journal of Ophthalmology explored the potential connection between the incidence / potential risk factors of cataract and patients with anterior uveitis.
First, how is cataract incidence defined here?
For this research, cataract incidence was determined by anterior uveitis patients with newly reduced visual acuity (VA) worse than 20/40 attributed to cataract—or incident cataract surgery.
Gotcha. Now talk about this study.
Investigators conducted a retrospective, multicenter cohort analysis on cataract incidence (with data harvested by trained expert reviewers using a protocol-driven chart review) from 2,567 patients (3,923 eyes) over a 5-year period.
Patients had one of three types of anterior uveitis:
- Primary acute anterior uveitis (13%)
- Recurrent acute anterior uveitis (52%)
- Chronic anterior uveitis (35%)
Findings?
Of the total number of patient eyes, 507 eyes (13%) developed visually significant cataract during follow-up.
What were the risk factors for cataract development?
Per the research, adjusted hazard ratio (HR) for risk factors included:
- Older age (65+ years); HR = 5.04
- Higher anterior chamber cell (ACC) grade; HR = 2.60
- Prior incisional glaucoma surgery; HR = 1.86
- Band keratopathy; HR = 2.23
- Posterior synechiae; HR = 3.71
- Elevated intraocular pressure (IOP) (≥30 mmHg).; HR = 2.57
Which types of anterior uveitis had the lowest cataract risk?
The investigators reported that primary acute (HR=0.59; 95% confidence interval [CI], 0.30-1.15) and recurrent acute (aHR=0.74; 95%CI, 0.55-0.98) had a lower risk for cataracts compared to chronic anterior uveitis.In all, cataract was noted as complicating anterior uveitis in ∼5.4/100 eye-years.
How about in relation to corticosteroids?
Per the study findings, a higher dose (≥2 drops/day) of a prednisolone acetate 1%-equivalent was associated with a >2-fold higher cataract risk among eyes with ACC grades of 0.5 or greater.
However, this higher dosage was not associated with a higher cataract risk when the ACC grade was less than or equal to 1+.
Meaning …
The data suggests that high-dose topical corticosteroids can be used freely for controlling active inflammation; however, they “need to be minimized for maintenance/suppressive therapy as much as possible in noncataractous eyes,” the authors noted.
Conclusion?
Topical corticosteroids were only associated with increased cataract risk when anterior chamber cells were absent or minimally present, suggesting that their use to treat active inflammation (which itself is cataractogenic) does not cause a net increase in cataract incidence.