This retrospective study shows that aggressive control of inflammation in patients with juvenile idiopathic arthritis (JIA)-associated uveitis may reduce their risk of hypotony.
The authors set out to describe risk factors for hypotony and, as expected, found that the condition is associated with signs of active and severe uveitis.
But the most interesting finding is that the risk decreased in patients receiving systemic immunosuppression, which suggests that ophthalmologist should aggressively treat ocular inflammation in patients with JIA-uveitis, often in collaboration with pediatric rheumatologists, to achieve the best visual outcome for their patients.
The review included 108 patients (196 eyes) with JIA-associated uveitis who were treated at Wilmer Eye Institute between 1984 and 2014. Hypotony, defined as IOP less than 5 mmHg, occurred in 7.1%, which is comparable to the range reported in other cohorts. The rate of developing hypotony and low IOP (< 8 mmHg) were 0.04 per eye-year and 0.06 per eye-year, respectively.
The likelihood of developing hypotony during follow-up was 43-fold higher among patients with panuveitis (P=0.004), 25-fold higher among those with anterior chamber cells or flare ≥3+ (P<0.001), 6-fold higher among those with posterior synechiae (P=0.02), and 29-fold higher among those using oral corticosteroid at presentation (P=0.003).
The use of immunosuppresive agents was associated with a decrease in the rate of developing hypotony (P=0.002), even after adjusting for confounding factors. This further underscores the importance of early and aggressive treatment with immunosuppressive drug therapy in JIA-associated uveitis.