5-year longitudinal study of clinical and patient-reported outcomes in acute anterior uveitis.

INTRODUCTION: Acute anterior uveitis (AAU) is a frequently encountered form of uveitis, most commonly an immune-mediated condition associated with the HLA-B27 gene with or without spondyloarthritis, or idiopathic in nature. This study's aim was to measure clinical and patient-reported outcomes 5 years after the first episode of immune-mediated AAU. METHODS: This is a longitudinal observational study. Ninety-six patients who underwent evaluation at the time of presentation with their first episode of AAU were invited to return for evaluation 5 years later. Standardised ocular history, clinical examination and quality of life (QOL) assessment with the Short Form 36 (SF-36) and the Vision Core Measure 1 (VCM 1) questionnaire were completed and analysed. RESULTS: Fifty-four patients (56%) returned for subsequent assessment. Physical function was the only sub scale domain of the SF-36 that had significantly deteriorated over the 5 years since the first episode of AAU (45.95 vs. 49.37, p = 0.003). Only 7.4% (n = 4) of patients expressed "more than a little concern" regarding their vision, reflected by a VCM1 score of 2.0 or more. At 5 years, the mean best corrected visual acuity (BCVA) of eyes affected by AAU was LogMAR 0.02 and only 3% (n = 2) of eyes had a BCVA of less than Logmar of 0.3. Five affected eyes (8%) had developed cataract and no patients had developed glaucoma by the 5 year review. CONCLUSIONS: This study demonstrates that immune-mediated AAU has an excellent 5 year prognosis with minimal impact on patients' health and vision-related quality of life.

High-risk Corneal Transplantation: Recent Developments and Future Possibilities.

Human corneal transplantation (keratoplasty) is typically considered to have superior short- and long-term outcomes and lower requirement for immunosuppression compared to solid organ transplants because of the inherent immune privilege and tolerogenic mechanisms associated with the anterior segment of the eye. However, in a substantial proportion of corneal transplants, the rates of acute rejection and/or graft failure are comparable to or greater than those of the commonly transplanted solid organs. Critically, while registry data and observational studies have helped to identify factors that are associated with increased risk of corneal transplant failure, the extent to which these risk factors operate through enhancing immune-mediated rejection is less clear. In this overview, we summarize a range of important recent clinical and basic insights related to high-risk corneal transplantation, the factors associated with graft failure, and the immunological basis of corneal allograft rejection. We highlight critical research areas from which continued progress is likely to drive improvements in the long-term survival of high-risk corneal transplants. These include further development and clinical testing of predictive risk scores and assays; greater use of multicenter clinical trials to optimize immunosuppressive therapy in high-risk recipients and robust clinical translation of novel, mechanistically-targeted immunomodulatory and regenerative therapies that are emerging from basic science laboratories. We also emphasize the relative lack of knowledge regarding transplant outcomes for infection-related corneal diseases that are common in the developing world and the potential for greater cross-pollination and synergy between corneal and solid organ transplant research communities.