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W.–C.M. Liu, K. Narayana, P. Latkany, C.M. Samson; Long Term Follow Up Of Patients With Pediatric Uveitis: A Retrospective Study . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2435.
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To evaluate clinical characteristics of patients with pediatric uveitis including vision loss, ocular complications, and response to treatment
We retrospectively reviewed the records of 24 patients seen at the New York Eye and Ear Infirmary Uveitis Clinic and the private office of one of the authors with onset of uveitis at 16 years of age or younger. The etiology of uveitis, visual results, complications encountered, and treatment administered were analyzed. We compared the visual acuity at first visit, 1 year follow–up, and annually thereafter up to the last visit.
Average age at first visit was 12 years. 71% of the patients were female and 29% male. Average length of follow–up was 4 years (range 2–149 months). Uveitis associated with juvenile idiopathic arthritis (JIA) was the largest group (14 patients, 58%), followed by idiopathic (29%). Anatomically, anterior uveitis was the most common (15 patients, 63%), followed by panuveitis (25%), posterior uveitis (8%), and intermediate uveitis (4%). 92% of the patients had bilateral disease. 65% of eyes had vision between 20/20 and 20/50, 29% between 20/60 and 20/200, and 6% worse than 20/200 at the initial visit. Complications included cataract in 15 patients (63%), CME and band keratopathy in 38%, glaucoma in 25%, and hypotony in 13%. For treatment, 96% of patients used topical steroids, with 63% using oral steroids at some point during follow–up. 92% of patients received chronic immunomodulatory therapy, with methotrexate being the most commonly used agent (95%). 42% needed surgical treatment with cataract extraction and glaucoma filtering procedures being the most common. At the 1 year follow–up, 66% of eyes had visual acuity between 20/20 to 20/50, 27% between 20/60 to 20/200, and 7% worse than 20/200. At the 2 year follow–up, visual acuity was 20/20 to 20/50 in 74% of eyes, 20/60 to20/200 in 13%, and worse than 20/200 in 13%. At 4 year follow–up, visual acuity was 20/20 to 20/50 in 75% of eyes, 20/60 to 20/200 in 14%, and worse than 20/200 in 11%. At the last follow–up visit, visual acuity was stable or better in 83% of eyes.
JIA remains the most common cause of pediatric uveitis in our study population. Although ocular complications can potentially lead to significant visual impairment, our study shows that with chronic immunomodulatory therapy and careful follow–up, long term preservation of vision is possible in the majority of this subset of patients.
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