To evaluate the risk of and risk factors for hypopyon among patients with uveitis, and to evaluate the risk of visual changes and structural complications following hypopyon.
Retrospective cohort study.
Patients with uveitis at four academic ocular inflammation subspecialty practices.
Data were ascertained by standardized chart review.
MAIN OUTCOME MEASURES
Prevalence and incidence of hypopyon, risk factors for hypopyon, and incidence of visual acuity changes and of structural ocular complications following hypopyon.
Among 4,911 patients with uveitis, 41 (8.3/1000) cases of hypopyon were identified at the time of cohort entry. Of these, 2,885 initially free of hypopyon were followed over 9,451 person-years, during which 81 (2.8%) developed hypopyon (8.57/1000 person-years). Risk factors for incident hypopyon included Behçet’s disease (adjusted relative risk (RR)=5.30, 95% confidence interval (CI): 2.76–10.2), diagnosis of a spondyloarthropathy (adjusted RR=2.86, 95% CI: 1.48–5.52), and HLA-B27 positivity (adjusted RR=2.04, 95% CI: 1.17–3.56). Patients with both a spondyloarthropathy and HLA-B27 tended to have higher risk than either factor alone (crude RR=4.39, 95% CI: 2.26–8.51). Diagnosis of intermediate uveitis (+/− anterior uveitis) was associated with a lower risk of hypopyon (with respect to anterior uveitis only, adjusted RR=0.35, 95% CI: 0.15–0.85). Hypopyon incidence tended to be lower among patients with sarcoidosis (crude RR=0.22, 95% CI: 0.06–0.90; adjusted RR=−0.28, 95% CI: 0.07–1.15). Post-hypopyon eyes and eyes not developing hypopyon had a similar incidence of band keratopathy, posterior synechiae, ocular hypertension, hypotony, macular edema, epiretinal membrane, cataract surgery, or glaucoma surgery. Post-hypopyon eyes were more likely than eyes which not developing hypopyon to gain 3 lines of vision (crude RR=1.54, 95% CI: 1.05–2.24) and were less likely to develop 20/200 or worse visual acuity (crude RR=0.41, 95% CI: 0.17–0.99); otherwise visual outcomes were similar in these groups.
Hypopyon is an uncommon occurrence in patients with uveitis. Risk factors included Behçet’s disease, HLA-B27 positivity, and diagnosis of a spondyloarthropathy. Intermediate uveitis cases (+/− anterior uveitis) had lower risk of hypopyon than other forms of uveitis. On average, post-hypopyon eyes were no more likely than other eyes with uveitis to develop structural ocular complications or lose visual acuity.