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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, Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Research Group; Risk of Elevated Intraocular Pressure (IOP) in Pediatric Non-infectious Uveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):844.
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To assess the risk and risk factors for elevated IOP in children with non-infectious uveitis.
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).
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.
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.
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