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B. Bodaghi, S. Prazeres, M. D. Becker, C. Terrada, P. LeHoang, T. Barisani-Asenbauer, F. Mackensen; Epidemiology of Childhood Uveitis: Results of an International Retrospective Multicenter Analysis of Uveitis Patients < 19 years. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5827.
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© ARVO (1962-2015); The Authors (2016-present)
To describe etiologies, disease activity, and prognosis of pediatric uveitis.
Databases review from 3 European uveitis centers with standardized definitions and time points.
426 patients with follow-up of 1-10 yrs were identified, 326 could be analyzed completely to date. Median age at presentation was 11.0 years, median age at first diagnosis 9 years. Gender distribution was F:M 1.2:1.The most frequent diagnoses were JIA (30.8%), idiopathic uveitis (30.2%) and infectious uveitis/toxoplasmosis (11.7/6.7%).Uveitis was active as judged by SUN criteria in 79% of children at the first visit and in 40% at the 5 year visit. Legal blindness (VA ≤ 20/200 in the better eye) was diagnosed in 4% at the first visit and 13% at the 5 year and 12.5% at the 10 year visit.There was a negative correlation between VA ≥ 20/50 and complications at first visit, especially band keratopathy and epiretinal membrane (p = 0.0425 and 0.05), CME and cataract (p = 0.05).At first visit a mean number of 1.7 complications were present per child: the most frequent complications were cataract (22%) and CME (11.6 %). Hypotony and Glaucoma were infrequent with 1.6% and 0.6%.In the group of children followed for at least 5 years, 46% had cataract, 15.38% had CME, and 25% had glaucoma at some time during this period.91% received systemic immunosuppressive therapy at any time, which involved combination therapy of prednisone (or equivalent) and systemic immunosuppressive drugs (including biologics) in 37%. Use of systemic immunosuppressive drugs such as methotrexate alone or in combination was frequent (52%) as was use of biologics with (10%).A third of children (29%) had surgery during the observed period. Cataract extraction was the most frequent type of surgery (79%), followed by Glaucoma and posterior segment surgery in 22%.
Children with uveitis followed by specialized centers over a long period of time have active and severe disease which requires intensive treatment, frequently involving systemic immunosuppressive drugs including biologics. Still only 12-13% of them showed legal blindness at the 5-10 year time point, a number smaller than observed historically, that will hopefully further decline with the increasing availability of a range of systemic immunosuppressive drugs.
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