Clinical Spectrum of HLA-B27-associated Ocular Inflammation

Area of Science:

• Ophthalmology
• Immunology
• Rheumatology

Background:

• Human leukocyte antigen (HLA)-B27-associated anterior uveitis (AU) is the most frequent form of non-infectious uveitis globally.
• It typically manifests as acute, unilateral AU in young adults (20-40 years old).
• The condition is characterized by recurrent episodes with remissions, usually resolving within three months.

Purpose of the Study:

• To describe the clinical characteristics, complications, and visual outcomes of HLA-B27-associated anterior uveitis.
• To compare outcomes between HLA-B27-positive and negative patients.
• To introduce a novel algorithm for patient referral.

Main Methods:

• Review of clinical presentations and disease patterns.
• Analysis of ocular complications and visual prognosis.
• Introduction of the Dublin Uveitis Evaluation Tool (DUET) algorithm.

Main Results:

• HLA-B27-associated AU typically presents with severe anterior chamber inflammation, fibrinous exudate, and potential synechiae or hypopyon.
• Recurrence is common, but the visual prognosis is favorable, with <2% legal blindness and <5% visual impairment.
• Less typical forms include chronic inflammation, posterior segment involvement, and episcleritis/scleritis.

Conclusions:

• HLA-B27-associated AU is a distinct clinical entity with a generally good visual outcome.
• Ocular complications like posterior synechiae, cataract, and glaucoma can occur.
• The DUET algorithm can assist in managing HLA-B27-positive uveitis patients by guiding referrals to rheumatologists.