April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Risk of Elevated Intraocular Pressure (IOP) in Pediatric Non-infectious Uveitis
Author Affiliations & Notes
  • Srishti Kothari
    The Massachusetts Eye Research and Surgery Institute, Cambridge, MA
    The Scheie Eye Institute, Department of Ophthalmology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
  • Maxwell Pistilli
    Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
  • C Stephen Foster
    The Massachusetts Eye Research and Surgery Institute, Cambridge, MA
    Department of Ophthalmology, Harvard Medical School, Boston, MA
  • H Nida Sen
    Laboratory of Immunology, National Eye Institute, Bethesda, MD
  • Eric B Suhler
    Department of Ophthalmology, Oregan Health and Science University, Portland, OR
    Portland Veteran’s Affairs Medical Center, Portland, OR
  • Jennifer E Thorne
    Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD
    The Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
  • Douglas A Jabs
    The Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, NY
    Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY
  • Robert B Nussenblatt
    Laboratory of Immunology, National Eye Institute, Bethesda, MD
  • James T Rosenbaum
    Department of Ophthalmology, Oregan Health and Science University, Portland, OR
    Department of Medicine, Oregan Health and Science University, Portland, OR
  • John H Kempen
    The Scheie Eye Institute, Department of Ophthalmology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
    Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
  • Footnotes
    Commercial Relationships Srishti Kothari, None; Maxwell Pistilli, None; C Stephen Foster, None; H Nida Sen, None; Eric Suhler, None; Jennifer Thorne, None; Douglas Jabs, None; Robert Nussenblatt, None; James Rosenbaum, None; John Kempen, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 844. doi:
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    • Get Citation

      Srishti Kothari, Maxwell Pistilli, C Stephen Foster, H Nida Sen, Eric B Suhler, Jennifer E Thorne, Douglas A Jabs, Robert B Nussenblatt, James T Rosenbaum, John H Kempen, ; Risk of Elevated Intraocular Pressure (IOP) in Pediatric Non-infectious Uveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):844.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To assess the risk and risk factors for elevated IOP in children with non-infectious uveitis.

 
Methods
 

Data obtained for 1593 eyes of 916 patients <18 years old, identified from a retrospective study cohort at 5 uveitis centers. Main outcome measures were IOP≥21 (≥21) or IOP≥30 (≥30)mmHg or IOP increase of ≥10mmHg (≥+10) from baseline, each counted as present if IOP-lowering medication was in use and/or the eye had undergone IOP-lowering surgery (IOPRx).

 
Results
 

Initially, 251 eyes (15.8%) had IOP≥21; among these, 46 eyes (2.9%) had IOP≥30. Risk factors for presenting IOP elevation included contralateral IOP elevations (≥21 and/or use of IOPRx): adjusted odds ratio(aOR)=16.8 for ≥21 and aOR=51.6 for ≥30; each p<0.001. Topical corticosteroid use, was associated with up to an 8-fold higher adjusted odds at higher doses. Additional risk factors included presenting visual acuity 20/200 or worse, unilateral uveitis, duration of uveitis of 2-5 years (vs other durations), prior cataract surgery, age 6-12 years (vs other pediatric ages, significant for ≥21 only) and Adamantiades-Behçet Disease (≥30 only). During follow-up of 689 eyes for a median of 455 days (25-75%ile,147-1337), 2-year cumulative incidence estimates for ≥21, ≥30 and ≥+10 were 33.4% (95% confidence interval [CI]: 27.9-38.5%), 14.8% (95% CI: 10.7-18.7%) and 24.4% (95% CI: 19.7-28.8%) respectively. Significant risk factors were pars plana vitrectomy (≥21 only), contralateral IOP elevations (aHR [adjusted hazard ratio]=2.57 for ≥21, aHR=3.60 for ≥30; each P<0.001; aHR=1.75 for ≥+10, p<0.03), use of periocular (over 4-fold higher risk), topical (up to 9-fold, higher risk at higher doses) and intraocular (aHR=7.11 for ≥21; aHR=20.7 for ≥30) corticosteroids.

 
Conclusions
 

Elevation of IOP affects a large minority of pediatric non-infectious uveitis cases. Among the various risk factors identified, IOP elevations in the fellow eye and the use of regional corticosteroids were associated with much higher risk (intraocular [had exceptionally high risk] > topical prednisolone acetate 1% equivalent [TPE]) 4 drops/day > periocular > 3 drops/day TPE). Pediatric non-infectious uveitis should be followed closely for IOP elevation. While ensuring control of inflammation, minimization of the use of corticosteroids (especially intraocular), to the extent it is possible, would be expected to lower the risk of IOP elevation.

 
 
Kaplan Meier Estimate: Incidence of IOP ≥30mmHg
 
Kaplan Meier Estimate: Incidence of IOP ≥30mmHg
 
Keywords: 463 clinical (human) or epidemiologic studies: prevalence/incidence • 745 uvea • 568 intraocular pressure  
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