A 26-year-old HLA-B27 positive man presents with recurrent acute anterior uveitis (3rd episode). He has bilateral sacroiliac joint pain. The most important ophthalmological complication of chronic recurrent HLA-B27 associated anterior uveitis that must be monitored is:

• A Band keratopathy
• B Rubeosis iridis (iris neovascularisation)
• C Retinitis pigmentosa pattern from chronic inflammation
• D Cystoid macular oedema and hypotony-related maculopathy ✓

Explanation

HLA-B27 associated anterior uveitis is typically fibrinous, unilateral, alternating, and associated with seronegative spondyloarthropathies. Chronic or recurrent attacks lead to posterior synechiae, complicated cataract, glaucoma, and most importantly cystoid macular oedema (CME) which is the leading cause of visual loss in these patients. CME is detected by OCT and treated with periocular/systemic steroids or anti-VEGF. Band keratopathy is more typical of JIA-associated chronic uveitis (low-grade, younger patients). Rubeosis and RP-pattern are not characteristically associated.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.