Purpose:
To describe the etiologies, disease activity, complications and visual outcome of pediatric uveitis.
Methods:
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.
Results:
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%.
Conclusions:
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.
Keywords: uveitis-clinical/animal model • clinical (human) or epidemiologic studies: outcomes/complications • inflammation