1. May 2014 Uveitis and HLA B27 Carol Slight Nurse Practitioner Ophthalmology

2. May 2014 What is uveitis? ► Why is classification important? ► Not a single disease ► Encompasses entire range of inflammatory conditions of the uveal tract (iris, ciliary body and choroid). ► Classified as 1. Acute or chronic or recurrent 1. Acute or chronic or recurrent 2. Unilateral or bilateral or alternating 2. Unilateral or bilateral or alternating 3. Granulomatous or non granulomatous 3. Granulomatous or non granulomatous 4. Anterior, intermediate, posterior or pan uveitis 4. Anterior, intermediate, posterior or pan uveitis

3. May 2014 HLA B27 uveitis ► Using the previous classification 1. Usually acute or recurrent 1. Usually acute or recurrent 2. Usually unilateral or alternating 2. Usually unilateral or alternating 3. Non granulomatous 3. Non granulomatous 4. Usually anterior 4. Usually anterior

4. May 2014 HLA B27 associated uveitis ► Gene located on short arm of chromosome 6 ► Present in 1-8% of population ► Associated uveitis affects males more than females ► Often severe with fibrin and hypopyon ► Recurrent course can involve both eyes not usually simultaneously ► HLA B27 diseases known as spondyloarthropathies

5. May 2014 Associated systemic HLA B27+ve diseases ► Ankylosing Spondylitis ► Reactive arthritis (Reiter syndrome) ► Inflammatory bowel disease ► Psoriatic arthritis ► Undifferentiated spondyloarthropathy

6. May 2014 Symptoms ► Red eye ► Pt often described bruised feeling above affected eye ► Photophobia ► May or may not have decreased visual acuity

7. May 2014 Signs ► Circumcorneal injection ► Fine keratic precipitates (KP’s) ► Distortion of pupil with Posterior synechiae ► Lower IOP Posterior synechiae Fine KP’s Circumcorneal injection

8. May 2014 Signs ► White blood cells in anterior chamber (AC) ► Possible flare in AC ► Possible hypopyon or fibrin in AC ► Inflammation in vitreous spillover WBC ► Usually does not involve posterior segment Cells Flare Hypopyon Fibrin

9. May 2014 Treatment ► Gutt Pred forte intensively ► Mydriatic TDS usually cyclopentolate ► Oc maxidex nocte ► ½ hourly 1/7- hourly 5/7- 2 hourly 1/52 6 x day 1/52, QID 1/52, TDS 1/52, BD 1/52, daily 1/52 6 x day 1/52, QID 1/52, TDS 1/52, BD 1/52, daily 1/52 ► Fu dependent on severity and how well settling ► Usually can discharge when drops minimal ► Most pts are aware of symptoms and will return early

10. May 2014 Auckland’s HLA B27 uveitis ► From 1153 pts with uveitis ► 330 HLA B 27+ve 28.6% ► Caucasian 199 60.3% ► Maori 30 9.09% ► Polynesian 29 8.78% ► East Asian 43 13.03% ► Indian 26 7.87% ► Others 3 0.9%

11. May 2014 Demographics ► HLA B27+ve uveitis ► Males 211 64% ► Females 119 36% Uveitis numbers all causes 1153 ► Males 620 53.8% ► Females 533 46.2 %

12. May 2014 Age at first diagnosis of HLA B27+ve uveitis

13. May 2014 Summary ► HLA B 27+ve uveitis can be associated with other systemic conditions ► Can be HLA B27+ve with no other associations ► Usually follows a pattern of unilateral inflammation although can alternate eyes ► Usually settles for period of time ► Less likely to get complications but still possible to develop CMO, steroid induced OHT and posterior involvement