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Anh Hong Nguyen, Bethlehem Mekonnen, Eric Kim, Nisha Acharya; Clinical Outcomes of Pediatric Macular Edema. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2065.
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© ARVO (1962-2015); The Authors (2016-present)
Macular edema (ME) is the most frequent cause of irreversible visual impairment in patients with uveitis. To date, little data exists about the clinical course of ME in pediatric patients. We performed a retrospective, observational study to examine the visual and macular thickness outcomes of pediatric patients presenting to a tertiary care center with ME associated with chronic, noninfectious uveitis.
Pediatric patients with noninfectious uveitis complicated by ME seen in the University of California San Francisco Health System from 2012-2018 were identified using ICD-9 and 10 codes. Electronic medical record review was conducted to verify diagnosis and collect additional information. We recorded demographic data, diagnosis, ocular history, central subfield thickness as measured by optical coherence tomography (OCT), complications, and treatments at first encounter and at 3, 6, 9, and 12-month follow-up visits. Cox proportional hazards regression was used to investigate the association between resolution of macular edema and different classes of treatment (steroid drops, injections, oral steroids and other immunosuppressive therapy).
The cohort comprised of 21 children (26 eyes) with a history of uveitis and ME. 16 patients were female and the mean age was 11.5 years (SD 4). Undifferentiated uveitis was the most common diagnosis, affecting 19 eyes (73.1%). The majority of observed uveitis was bilateral (16 patients, 76.2%).The median duration of follow-up at UCSF was 26 months (IQR 13-49 months).Average central macular thickness (CMT) at the time of initial ME diagnosis was 559.5 microns (SD 248) . Mean CMT reduced to 275.5 microns (SD 17.7) at the 12-month mark. Mean best corrected visual acuity (BCVA) at baseline was 0.64 logMAR (SD 0.39, 20/80 Snellen equivalent). Mean BCVA at 12 months was 0.25 logMAR (SD 0.34, 20/35).By 12 months, 72.2% (13 of 18 eyes) had achieved resolution of ME. The median time to resolution was 12 months (IQR 9 – 12 months). Corticosteroid injections were associated with a 6.4-fold higher rate of macular edema resolution (95%CI 1.8, 22.2, P<0.001).
The majority of pediatric patients with uveitic ME achieved resolution within the 12-month period of this study. On average, patients had an improvement in visual acuity and reduction in central macular thickness. Corticosteroid injections were associated with resolution of macular edema.
This is a 2020 ARVO Annual Meeting abstract.
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