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J.A. Smith, F. Mackensen, J.R. Smith, J. Freidlin, N. Sen, A. Watkins, H. Tessler, D. Pyatesky, R. Nussenblatt, D.A. Goldstein; Epidemiology and Course of Disease in Childhood Uveitis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2434.
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To describe the etiologies, disease activity, complications and visual outcome of pediatric uveitis.
Databases from 3 uveitis centers in different regions of the US were reviewed. Demographics, nature of uveitis, time course, complications, treatment and visual outcomes at specified time points were recorded in a standardized manner. The Standardized Uveitis Nomenclature (SUN) definitions of disease activity were used to report the clinical data.
234 patients were identified: 51.3% female, 62% White, 18.8% unknown race, 14.1% Black, 3.4% Asian, 1.7% mixed race and 15% Hispanic. Median age at diagnosis was 9.1 yrs. The most frequent diagnoses were idiopathic uveitis and pars planitis both with 23.2%, juvenile idiopathic arthritis 19.7%, toxoplasmosis 4.7%, infection 4.2%, VKH 2.9%, sarcoidosis 2.6%, HLA b27 2.1% and Behcet’s 2.1%. The primary symptom was red eye in 23%, decreased vision 22%, routine exam 15%, floaters 6% and school eye exam 5%. Uveitis was bilateral in 79% and disease onset was sudden in 38% and insidious in 54%. The duration of disease was persistent in 76% and limited in 17%. Disease course was acute in 10%, recurrent in 7%, chronic with relapse after stopping treatment in 37%, chronic in 8% and did not meet SUN criteria in 6%. Treatment included steroids 86 %, NSAIDS 17.5 %, methotrexate 11 %, cyclosporine 9%, TNF alpha inhibitor 6.8%, mycophenolate mofetil 4% and cyclophosphamide 1.2%. 18.3% of patients experienced treatment limiting side effects from medications other than steroids. Surgery was performed in 18.4% of patients: cataract 12%, posterior segment 7.3%, glaucoma 4.2% and cornea 2.5%.
Despite treatment, the rate of complications of uveitis persists with time. Prospective studies are needed to identify children most at risk and determine the benefit of early diagnosis and treatment.
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