Skip to main content

  • Long-Term Outcomes for Pediatric Intermediate Uveitis

    By Lynda Seminara
    Selected by Richard K. Parrish II, MD
    Add to My Bookmarks

    Journal Highlights

    American Journal of Ophthalmology, May 2022

    Download PDF

    Albloushi et al. set out to better understand the course and outcomes of pediatric idiopathic intermediate uveitis (IIU). Although the researchers noted a trend toward lifelong inflammatory complications, they found that good vision was retained long-term in most patients. In moderate cases, steroid-sparing immunomodulatory therapy (IMT) was somewhat protective against cystoid macular edema and ocular hypertension.

    The study cohort included 125 chil­dren (221 eyes) under 17 years of age with IIU (per the Standardization of Uveitis Nomenclature [SUN] defi­nition) but no systemic disease. The children, 56.8% of whom were boys, were treated at Moorfields Eye Hospital between 1992 and 2020. Main outcomes were VA, inflammation severity, and occurrence of sight-threatening com­plications.

    At presentation, 29 of the children (23.2%) had unilateral uveitis, and 18 (14.4%) were asymptomatic. All eyes had vitreous involvement, and 35 had substantial vitreous haze (SUN score ≥2). In 11 eyes, BCVA was worse than 20/160. Second-line IMT was used in 41 children, 27 of whom received methotrexate. The most common irre­versible structural findings were ocular hypertension, cataract, and macular edema (65 [29.4%], 41 [18.5%], and 29 [13.1%], respectively). The mean follow-up time was 72.4 months (median, 57 months).

    At the final visit, no patient had a SUN score ≥2, and 116 patients (92.8%) had BCVA of 20/40 of better and “quiet eyes.” Factors that raised the risk of new-onset macular edema were naivete to IMT (odds ratio [OR], 6.3; p < .001) and glaucoma occurrence during the observation period (OR, 6.6; p < .001). Secondary cataract was more common with longer follow-up.

    This study affirms earlier reports of retinal detachment, cystoid macular edema, and cataract being common causes of poor BCVA in IIU. Elevated IOP was another key sight-threatening finding in this study. On a positive note, IMT may control inflammation in IIU and its troubling consequences while also limiting corticosteroid use, said the authors. Their suggestions for future research include identifying potential IIU subtypes and exploring responses to the various IMTs used for management.

    The original article can be found here.