Ocular complications of pediatric uveitis

doi:10.1016/j.ophtha.2004.06.014

Ophthalmology

Volume 111, Issue 12, December 2004, Pages 2299-2306

https://doi.org/10.1016/j.ophtha.2004.06.014 Get rights and content

Purpose

To determine the cumulative proportion and the visual significance of ocular complications of pediatric uveitis.

Design

Cohort study.

Participants

Patients with onset of endogenous or infectious uveitis before or at age 16 years.

Methods

Retrospective review of existing records at a university-based uveitis clinic.

Main outcome measures

Type and prevalence of complications related to uveitis, time to development of complications, and vision loss after initial diagnosis.

Results

There were 148 patients, 71 males and 77 females, with a mean age of 10.4±4.9 years (median, 10.3 years) for an estimated prevalence of pediatric uveitis of 13.8%. Noninfectious uveitis was present in 112 patients (75.7%); 105 (71%) patients had bilateral disease. Anterior uveitis accounted for 30.4%, intermediate uveitis for 27.7%, posterior uveitis for 23.7%, and panuveitis for 18.2% of patients. Patients were followed for a mean of 71.7 months (range, 0 months–44 years) after diagnosis. Approximately 34% of all patients had 1 or more complications at the time of first diagnosis of uveitis by an ophthalmologist, increasing to 61.6% by 3 months, 69.4% by 6 months, 75.2% by 1 year, and 86.3% by 3 years after diagnosis. There were a total of 617 complications of all types. Anterior and intermediate uveitis had a higher risk of band keratopathy (P = 0.005). Posterior and intermediate uveitis had a lower risk of cataract (P = 0.009) or posterior synechiae (P<0.001). Intermediate uveitis had a higher risk of cystoid macular edema compared with anterior or posterior uveitis (P = 0.002). The cumulative percentages (standard error) of patients with first loss to 20/200 or worse after diagnosis in the affected eyes of unilateral cases or in either eye of the bilateral cases were: 31.3% (3.9) at 1 month; 40.5% (4.1) at 6 months; 56.0% (4.3) at 24 months; and 69.6% (4.5) at 60 months. Fifty-four patients (48.2%) received systemic antiinflammatory or immunomodulatory therapy. Sixty-eight patients (45.9%) had ocular surgery, and 38 of these had ocular surgery in both eyes.

Conclusions

Childhood uveitis is significant for numerous complications, many of which are vision threatening. Complications increase with duration of disease.

Section snippets

Materials and methods

The Human Subjects Research Subcommittee of the University of Miami School of Medicine approved the review of existing medical records with waiver of informed consent and authorization. We reviewed patient lists from the faculty and resident specialty uveitis clinics at Bascom Palmer Eye Institute to identify patients who had been diagnosed with uveitis at or before 16 years of age and who had at least 1 patient visit between 1996 and 2002. Patients were also included if the diagnosis of

Results

A total of 1073 patients with uveitis, who had been examined at least once in the uveitis clinics from 1996 to 2002, were identified from patient lists. One hundred twenty-four patients had been diagnosed with uveitis at age 16 years or younger. An additional 24 patients (16% of 148), not found on the patient lists, were recalled and added to the sample. Most patients were both diagnosed and seen for the first time during that period. The estimated prevalence of pediatric-onset uveitis in our

Discussion

The principal strength of this series is the reporting of complications and visions at standard intervals from diagnosis. Because we included data from patients whose diagnosis was made before presentation to our institution, the study was not prospective for all patients, and some inaccuracies in rates are expected. However, knowledge of the frequency of complications at certain intervals after diagnosis is extremely useful in counseling patients and in assessing needed sample sizes for trials

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Cited by (226)

Causes of infectious pediatric uveitis: A review
2024, Survey of Ophthalmology
Infectious pediatric uveitis is a rare disease that can cause severe ocular damage if not detected rapidly and treated properly. Additionally, early identification of an infection can protect the child from life-threatening systemic infection. Infectious uveitis can be congenital or acquired and may manifest as a primary ocular infection or as a reactivation. Nevertheless, publications on infectious paediatric uveitis are usually limited to a small number of patients or a case report. So far, most studies on uveitis in children have focused primarily on noninfectious uveitis, and a systematic study on infectious uveitis is lacking. In this review, we summarize the literature on infectious uveitis in pediatric populations and report on the epidemiology, pathophysiology, clinical signs, diagnostic tests, and treatment. We will describe the different possible pathogens causing uveitis in childhood by microbiological group (i.e. parasites, viruses, bacteria, and fungi). We aim to contribute to early diagnosis and management of infectious pediatric uveitis, which in turn might improve not only visual outcome, but also the general health outcome.
The Role of the Retinal Nerve Fiber Layer Thickness on OCT in the Evaluation of Papillitis in Childhood Uveitis
2023, American Journal of Ophthalmology
To investigate the diagnostic value of using retinal nerve fiber layer thickness measured on optical coherence tomography (OCT-RNFL) to diagnose papillitis in pediatric uveitis.
Retrospective cohort study.
Demographic and clinical data were collected retrospectively for 257 children with uveitis (with 455 affected eyes). Receiver operating characteristic (ROC) analysis was performed to compare fluorescein angiography (FA, the diagnostic gold standard for papillitis) to OCT-RNFL in a subgroup of 93 patients. An ideal cut-off value for OCT-RNFL was then determined by calculating the highest Youden index. Finally, a multivariate analysis was applied to the clinical ophthalmological data.
Based on a subset of 93 patients who underwent both OCT-RNFL and FA, the ideal cut-off OCT-RNFL for diagnosing papillitis was >130 µm, with 79% sensitivity and 85% specificity. Among the entire cohort, the prevalence of OCT-RNFL >130 µm was 19% (27/141), 72% (26/36), and 45% (36/80) in patients with anterior uveitis, intermediate uveitis, and panuveitis, respectively. Our multivariate analysis of the clinical data revealed that OCT-RNFL >130 µm was associated with a higher prevalence of cystoid macular edema, active uveitis, and optic disc swelling on fundoscopy, with odds ratios of 5.3, 4.3, and 13.7, respectively (all P < .001).
OCT-RNFL can be a useful noninvasive additional imaging tool for diagnosing papillitis in pediatric uveitis with relatively high sensitivity and specificity. OCT-RNFL was >130 µm in approximately one-third of all children with uveitis and was particularly prevalent in cases of intermediate uveitis and panuveitis.
Uveitis in children: Epidemiological, clinical and prognostic characteristics
2023, Journal Francais d'Ophtalmologie
The purpose of this study is to describe the characteristics and prognostic factors of pediatric uveitis in a French university referral hospital.
We performed a retrospective study of all cases of all pediatric uveitis seen at our institution over a 7-year period.
A total of 141 eyes of 86 children were included. The mean age was 10.7 years, and 61.6% were girls. The uveitis was bilateral in 64.0% of cases. Anterior uveitis (41.0%) and intermediate uveitis (32.0%) were the most frequent forms. The most frequent etiologies were idiopathic (27.9%), juvenile idiopathic arthritis (25.6%) and pars planitis (18.6%). During the follow-up period, systemic corticosteroids were received by 43.0% of children, immunosuppressive drugs by 31.4% and biological agents by 18.6%. At the final examination, complications were present in 67.0% of patients: 18.0% had cataracts, and 11.3% had intraocular hypertension. Posterior synechiae were present in 27.6% of eyes, optic disc edema in 10.5% and macular edema in 16.2%. At the last visit, visual acuity was better than 20/200 in 97.0% of cases. The presence of band keratopathy, cataract or glaucoma was an independent predictor of impaired visual outcomes at follow-up.
Juvenile idiopathic arthritis is one of the most frequent and severe pediatric uveitides. Close monitoring and early treatment could prevent complications.
L’objectif de cette étude est de décrire les caractéristiques et les facteurs pronostiques des uvéites pédiatriques dans un hôpital français universitaires de référence.
Nous avons réalisé une étude rétrospective de l’ensemble des cas d’uvéites pédiatriques vues dans notre centre sur une durée de 7 ans.
141 yeux de 86 enfants ont été inclus. L’âge moyen était de 10.7 ans et 61.6% étaient des filles. Les uvéites étaient bilatérales dans 64.0% des cas. Les uvéites antérieures (41.0%) et les uvéites intermédiaires (32.0%) étaient les formes les plus fréquentes. Les étiologies les plus représentées étaient les formes idiopathiques (27.9%), l’arthrite juvénile idiopathique (25.6%) et les pars planites (18.6%). Lors du suivi, la corticothérapie systémique a été prescrite chez 43.0% des enfants, les immunosuppresseurs chez 31.4% et les anti TNFα chez 18.6% des enfants. Lors de l’examen final, les complications étaient présentes chez 67.0% des patients: 18.0% avaient une cataracte et 11.3% avaient une hypertension intraoculaire. Les synéchies postérieures étaient retrouvées dans 27.6% des yeux, l’œdème papillaire dans 10.5% et l’œdème maculaire dans 16.2% des yeux. Lors de la dernière consultation, l’acuité visuelle était supérieure à 20/200 dans 97.0% des cas. La présence d’une kératite en bandelette, d’une cataracte ou d’un glaucome étaient des facteurs de risques indépendants d’une mauvaise acuité visuelle finale.
L’arthrite juvénile idiopathique est une des uvéites les plus fréquentes et les plus sévères chez l’enfant. Un suivi rapproché ainsi qu’un traitement précoce pourraient en prévenir les complications.
Alternative Biologic Therapy in Children Failing Conventional TNFα Inhibitors for Refractory, Noninfectious, Chronic Anterior Uveitis
2022, American Journal of Ophthalmology
A significant number of children with noninfectious, chronic anterior uveitis (CAU) fail to respond to conventional therapy; however, successful alternative biologic treatments (ABT) have not been well described. This study aims to review the clinical and treatment characteristics of children with CAU who require ABT.
Retrospective, nonrandomized clinical study.
Setting: Tertiary center. Study Population: Children with noninfectious CAU. Observation Procedures: Clinical characteristics, uveitis course, complications, and treatment were compared among patients treated with methotrexate (MTX) monotherapy, conventional TNFα inhibitors (cTNFi), and ABT for >3 months. Main Outcome Measure: Success of ABT (abatacept, tocilizumab, and/or golimumab) in children failing conventional treatment.
Of the 52 children with CAU, 75% had juvenile idiopathic arthritis. CAU was controlled in 15 children receiving MTX monotherapy, 28 receiving cTNFi, and 9 receiving ABT (n = 1, abatacept; n = 3, tocilizumab; n = 5, golimumab). Patients in the ABT group had a greater number of total ocular complications per person before ABT than those in the control groups (3.4 vs 0.7 [MTX], P < .001, and 1.5 [cTNFi], P < .001, respectively). In all 9 children on ABT, treatment led to control of CAU and topical glucocorticoids tapered to ≤2 drops/d with no new ocular complications.
In this study, alternative biologics (abatacept, golimumab, and tocilizumab) were useful for treating CAU in children who fail MTX and cTNFi therapy. Patients who were controlled on ABT had more disease activity, ocular complications, and anti-cTNFi neutralizing antibodies (before ABT) than those managed with conventional therapy. Larger studies are required to confirm these findings.
Long-Term Outcomes of Pediatric Idiopathic Intermediate Uveitis
2022, American Journal of Ophthalmology
To describe the course of childhood-onset intermediate uveitis without associated systemic disease, and investigate determinants of outcomes.
A retrospective clinical cohort study
This study was conducted in an institutional setting. A total of 125 children (221 eyes) aged 16 years and less participated. Outcomes of interest were visual acuity, severity of inflammation, and the occurrence of sight-threatening complications. Variables examined included age and clinical findings at presentation, treatment, and duration of follow-up. Multivariable analysis was undertaken to investigate potential predictors of outcomes.
The median follow-up duration was 57 months. At presentation, best-corrected visual acuity worse than 20/160 was recorded in 11 (4.4%) eyes and significant vitreous haze (≥2+Standardisation of Uveitis Nomenclature (SUN)) in 35 (14%) eyes. Corticosteroid-sparing agents were used in 41 children (33%), with methotrexate most commonly used (27 children, 21.6%). The most frequent complications were raised intraocular pressure (n = 65; 29.4%), cataract (n = 41; 18.5%), and cystoid macular edema (n = 29; 13.1%). At the last visit, 116 (92.8%) patients achieved best-corrected vision of 20/40 or better with quiescent uveitis. The absence of the use of a steroid-sparing immunomodulatory agent was the strongest predictive factor for the development of new macular edema (odds ratio = 6.3, 95% CI = 2.3–16.9, P < .001) or glaucoma (odds ratio = 6.6, 95% CI = 2.5–17.9, P < .001) over the period of observation.
The visual outcomes of childhood-onset idiopathic intermediate uveitis are favorable. The frequency of sight-threatening sequelae of inflammation, which confer a lifelong risk of further visual loss, is high. The use of immunomodulatory therapy is associated with a lower risk of developing macular edema and ocular hypertension.
Infliximab in chronic non-infectious paediatric uveitis refractory to previous biologic therapy
2024, Eye (Basingstoke)

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: Manuscript no. 230787.

: Supported by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York, and by the National Institutes of Health, Bethesda, Maryland (center grant no.: P30 EY14801).

: The authors have no financial interest in the subject matter of the article.

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Original articleOcular complications of pediatric uveitis

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

Causes and frequency of blindness in patients with intraocular inflammatory disease

Br J Ophthalmol

Original article
Ocular complications of pediatric uveitis