Minimizing surgical interventions may preserve corneal endothelium in children with uveitis

This prospective, longitudinal study assessed whether anterior chamber inflammation affects the corneal endothelium in children.

Study design

Researchers recruited 99 children with anterior uveitis and 11 controls. Specular microscopy was used to measure endothelial cell density (ECD), the coefficient of variability and hexagonality to evaluate cell morphology. Mean follow-up was 11 months. Patients who were naïve to surgery and patients who underwent surgery before or during the study were analyzed separately. The study parameters included patient age, serologic markers, level of immunosuppression, number of antiglaucoma medications, interval since diagnosis, duration of disease activity, maximum activity, maximum IOP and history of intraocular surgery.

Outcomes

There were no significant differences detected in uveitis activity parameters and morphological variables. The rate of ECD decline in patients with uveitis was comparable to age-matched controls. Analysis revealed that only a history of intraocular procedures associated with annual ECD loss (r=0.43).

Limitations

Since the cohort had well-controlled and a short duration of uveitis prior to enrollment in study, optimization of disease control may have eliminated the effect of active uveitis on ECD loss. Follow-up was relatively short; longer follow-up is needed to detect the cumulative effects of uveitis on ECD. The control group was significantly younger than the 2 uveitis groups.

Clinical significance

These findings suggest that active uveitis itself does not accelerate ECD loss. When managing children with uveitis, the goal should be to minimize complications that require surgical intervention.