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Anterior ischaemic optic neuropathy in a patient with HLA-B27 associated anterior uveitis and ankylosing spondylitis
  1. VIVIEN M-B THAM,
  2. EMMETT T CUNNINGHAM JR
  1. The Francis I Proctor Foundation and the Department of Ophthalmology, UCSF, Medical Center, San Francisco, CA 94143-0944, USA
  1. emmett{at}itsa.ucsf.edu

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Editor,—HLA-B27 positivity occurs in 40%–50% of patients with anterior uveitis.1 ,2 HLA-B27 associated anterior uveitis is typically non-granulomatous, recurrent, and unilateral or alternatingly bilateral. The most frequent systemic disease associations in HLA-B27 positive patients with anterior uveitis include ankylosing spondylitis, Reiter's syndrome, inflammatory bowel disease, and psoriatic arthritis.1 ,2 Ocular complications are more common in HLA-B27 positive patients with anterior uveitis compared with HLA-B27 negative patients,2 and include cataract formation, pupillary synechiae, secondary glaucoma, and cystoid macular oedema.1 ,2 Although severe vitreous inflammation and optic disc oedema can be seen in 15%–20% of patients with HLA-B27 associated anterior uveitis, ischaemic optic neuropathy is rare.3-6 We describe a patient who developed anterior ischaemic optic neuropathy in the setting of known HLA-B27 associated recurrent, anterior uveitis and ankylosing spondylitis.

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