Ken Ng, Aaron Wong, Joanne Sims

Aim: To describe the long term clinical outcomes of HLA B27 anterior uveitis in Maori and Pacific Island (MPI) people in New Zealand.

Method: A consecutive, comparative, retrospective case series of 21 MPI and 59 European patients diagnosed with first episode of HLA B27 anterior uveitis at the Auckland City Hospital and Greenlane Clinical Centre between January 2001 and December 2010 was conducted.

Results: MPI patients had similar age of onset (39.9vs 41.5 years) and male preponderance (62% vs 70%) compared to European patients. At first presentation, more MPI patients developed corneal oedema (33% vs 12%, p=0.04), hypopyon (19% vs 3%, p=0.04) and extensive posterior synechiae (50% vs 20%, p=0.01) compared to their European counterparts. Subsequently, MPI patients are at higher risks of developing chronic (57% vs 27%, p=0.02), recurrent (90% vs 66%, p=0.045) disease, complicated by multiple hypopyon (38% vs 5%, p=0.001), persistent posterior synechiae (43% vs 10%, p=0.002) and vitritis (29% vs 5%, p=0.009), compared to European patients. MPI patients were also more likely to receive oral prednisone treatment (29% vs 9%, p=0.03) and miss multiple follow-up opportunities than European patients (48% vs 5%, p<0.001). Following a median follow up time of 48 months (IQR 9.2-83), 94% and 99% of the affected eyes in the MPI and European groups respectively retained visual acuity of 6/15 or greater (p=0.89).

Conclusion: MPI patients are at greater risk of developing severe, chronic, recurrent HLA B27 anterior uveitis, which greatly increases the disease burden on these indigenous populations.