Good Visual Prognosis May Accompany Pediatric Uveitis Despite Complications

Pediatric uveitis can result from a number of etiologies and lead to several ocular complications, according to a study published in Journal Français d’Ophtalmologie. Visual prognosis, however, may be good in patients who receive close monitoring and timely treatment, the report suggests.   

Researchers performed a retroscopic analysis of 86 children with uveitis (61.6% girls; mean age, 10.7 years; eyes, 141) to identify the most common types of pediatric uveitis and prognostic outcomes. The children underwent comprehensive ophthalmic examinations, systemic macular and papillary tomography, and laser flare photometry. Some participants underwent fluorescein angiography and visual field testing based on age and clinical examination findings. 

Uveitis was present bilaterally in most cases (64%) with the most frequent types being anterior (41%) and intermediate uveitis (32%). The most frequent etiologies were idiopathic (27.9%), juvenile idiopathic arthritis (25.6%) and pars planitis (18.6%), according to the report. 

Common treatments included systemic corticosteroids (43.0%), immunosuppressive drugs (31.4%) and biological agents (18.6%). Complications were present in 67% of children and included posterior synechiae (27.6%), cataracts (18%), macular edema (16.2%), intraocular hypertension (11.3%), and optic disc edema (10.5%). 

Visual acuity prognostic outcomes were good, with 97% of participants achieving visual acuity of 20/200 or better, the report shows. A total of 90.5% of participants had a visual acuity better than 20/40 and 82.0% had a visual acuity better than 20/25 at the study conclusion. Band keratopathy (odds ratio [OR], 31.0; 95% CI, 5.7-168.1; P =.0001), cataract (OR, 15.0; 95% CI, 3.4-66.5; P =.0001), and glaucoma (OR, 8.5; 95% CI, 1.9-3.7; P =.005) presented the highest risk for developing visual acuity worse than 20/40. 

“Uveitis in children is rare but can lead to serious visual consequences,” according to the researchers. “The occurrence of ocular complications is the principal factor of poor prognosis. Complications can only be prevented by following these children carefully and early treatment. Monitoring of the benefit/risk ratio must be central to patient management.”

Study limitations include a retrospective nature and single center design.