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  • Younger age at diagnosis increases ocular complications in pediatric idiopathic CAU

    Pediatric Ophth/Strabismus, Uveitis

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    Review of: Clinical course and outcome in pediatric idiopathic chronic anterior uveitis

    Kouwenberg C, Wennink R, Shahabi M, et al. American Journal of Ophthalmology, September 2022

    In a cohort study, children with idiopathic chronic anterior uveitis (iCAU) diagnosed at a younger age were more likely to have long-term ocular complications than those diagnosed at an older age.

    Study design

    This was a retrospective cohort study comparing 2 groups of children with chronic anterior uveitis (CAU) (48 children per group): one group with juvenile idiopathic arthritis–associated uveitis (JIA-U) and one with iCAU. The primary outcome was the number of ocular complications in each population at 1 and 5 years follow-up; visual acuity and treatment modalities were secondary outcomes. The study was conducted at a pediatric uveitis referral center at an academic university in the Netherlands.

    Outcomes

    The rate of ocular complications was higher in children with iCAU, particularly those aged <8 years at diagnosis, than children with JIA-U. The iCAU group had a higher prevalence of posterior synechaie than the JIA-U group at the 1-year follow-up, but visual acuity (VA) had equalized in both groups at the 5-year follow-up. After 5 years, children with iCAU aged <8 years at diagnosis were found to have a greater rate of posterior synechaie, secondary glaucoma, and cataract surgery than children with iCAU aged >9 years at diagnosis.

    Limitations

    The study was limited by the retrospective electronic record review design, and that, initially, the children with iCAU had more severe disease compared with the children with JIA-U. In addition, the median VA at the 1-year follow-up was 20/25 in the iCAU group and 20/20 in the JIA-U group, which is non-amblyopic. In essence, the ocular complications reported in the iCAU group are not vision-threatening, based on the reported VA.

    Clinical significance

    Early diagnosis and detection of CAU is important, especially for children with iCAU aged <8 years. While there are established guidelines for ophthalmologic screening for children with JIA-U even when they are asymptomatic, children with iCAU will benefit from close follow-up to prevent ocular complications.