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M. A. Kapamajian, G. N. Holland, F. Yu, C. S. Denove, J. Caprioli; Chronic Anterior Uveitis in Children: Glaucoma and Elevated Intraocular Pressure. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5266.
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To describe glaucoma and elevated intraocular pressure (IOP) as a complication of chronic anterior uveitis (CAU) in children, and to identify associated risk factors.
Retrospective chart review of all children (age ≤16 yrs. at disease onset) with CAU who were examined by 1 clinician (1993-2006). Demographic, medical and ophthalmic data were collected. Prevalence of glaucoma/elevated IOP at presentation to a tertiary referral center (baseline) was determined. A relationship between anterior chamber (AC) cells (as a linear variable) and IOP at each visit was sought among patients without glaucoma/elevated IOP. A variety of host and disease characteristics at baseline, as well as time-dependent changes in AC cells and flare, were studied as risk factors for development of glaucoma/elevated IOP. Analyses utilized Kaplan-Meier technique and Cox proportional hazards regression models.
Included were 115 patients (200 involved eyes). Prevalence of glaucoma/elevated IOP at baseline was 12.5% (25 eyes). When all visits were considered, there was a weak, negative correlation between AC cell counts and IOP values at individual visits (n=1545, Spearman correlation coefficient, -0.064, p=0.012); the relationship was not present when only eyes not being treated with corticosteroids were considered. Incidence of glaucoma/elevated IOP during follow-up was 7.4/100 person-years. Baseline risk factors for glaucoma/elevated IOP during follow-up included younger age, signs of intermediate uveitis, and papillitis. Sustained improvement in flare (10% reduction or decrease of 10 pu/msec or decrease below 20 pu/msec) during follow-up was associated with a reduced risk of glaucoma/elevated IOP (RR 0.10 [95% CI 0.02-0.46], p=0.003), while sustained improvement in AC cells (by SUN Working Group criteria) was not (RR 0.65 [0.26-1.65], p=0.37). Risk of glaucoma/elevated IOP fell with increased duration of disease.
Glaucoma/elevated IOP is a common complication of CAU in children. It tends to occur early in the course of disease and is associated with more severe inflammation. Better control of inflammation may protect against development of this complication. The effect of corticosteroid treatment on intraocular pressure is a possible confounding factor that must be considered in evaluation of children for disease-associated glaucoma/elevated IOP and its relationship to severity of inflammation.
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