Association of Pediatric Atopic Dermatitis and Cataract Development and Surgery

Abstract

IMPORTANCE There is a paucity of data addressing the risk of cataract development in pediatric patients with atopic dermatitis (AD). OBJECTIVE To investigate the association of AD with subsequent cataract development and cataract surgery in a Korean pediatric population. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective longitudinal cohort study used nationally representative data from the Korean National Health Insurance Service database from 2002 to 2013. Incident AD cases, consisting of patients younger than 20 years with AD and severe AD and were matched to 4 controls each using propensity score derived from age, sex, residential area, and household income.MAIN OUTCOMES AND MEASURES Incidence probabilities of cataract development and cataract surgery between the AD group and controls were compared using Kaplan-Meier methods and log-rank tests. Cox proportional hazard models were fitted for cataract and cataract surgery to determine the risk factors in the matched cohort. RESULTSOf 34 375 patients with incident AD (16 159 girls [47%]; mean [SD] age, 3.47 [4.96] years), there were 3734 severe AD cases (10.9%) with 137 500 matched controls. Development of cataracts was not different between the AD and control groups, (0.216% vs 0.227%; 95% CI, −0.041% to 0.063%; P = .32) or between the severe AD cohort and their controls (0.520% vs 0.276%; 95% CI, −0.073% to 0.561%; P = .06). Cataract surgery was performed more frequently in the AD cohort than in the control group (0.075% vs 0.041%; 95% CI, 0.017%-0.050%; P = .02) and in the severe AD cohort compared with their controls (0.221% vs 0.070%; 95% CI, 0.021%-0.279%; P = .03). Severe AD was associated with both development of cataract (adjusted hazard ratio, 1.94; 95% CI, 1.06-3.58, P = .03) and requirement for cataract surgery (adjusted hazard ratio, 5.48; 95% CI, 1.90-15.79, P = .002).CONCLUSIONS AND RELEVANCE Absolute risk of cataract was rare, with or without AD, even after 10 years of observation. However, our results suggest that pediatric patients with AD have an increased risk for cataracts requiring surgery and that disease severity may increase the risk for cataract development and cataract surgery. JAMA Ophthalmol. 2018;136(8):912-918.

The Association with rhegmatogenous retinal detachment and paediatric atopic dermatitis: a 12-year Nationwide Cohort Study

“…Atopic dermatitis (AD) is a common chronic inflammatory skin disease of childhood, affecting between 10% and 20% of children in industrialised countries [ 1 – 3 ]. Patients with AD are frequently predisposed to ocular complications, such as blepharitis, keratoconjunctivitis, keratoconus, cataract, and rhegmatogenous retinal detachment (RRD) [ 1 , 4 , 5 ]. Of these, RRD is the most serious complication; it can lead to the loss of vision [ 6 ], which could be a great obstacle in life for young patients.…”

“…[ 4 , 7 – 11 ] Postulated mechanisms of RRD in those with AD include trauma such as rubbing eyes repeatedly for relieving itching, which affects the occurrence of RRD. [ 4 , 7 – 11 ] In addition, one of the other ophthalmic complications of AD is cataract, and it is reported that cataract surgery itself can cause RRD [ 5 , 12 ]. Therefore, it is important to analyse the association between AD and RRD occurrence in conjunction with several comorbidities.…”

Anterior lenticular opacities in Costello Syndrome

“… 8 However, the type of cataract in these patients is usually anterior or posterior sub-capsular unlike in our patient who had anterior capsular plaques as well as nuclear lenticular opacities. 8 , 9 …”

Atopic Dermatitis—Beyond the Skin

“…An association between the development of cataracts and increased IgE serum levels, the duration of the topic cortical therapy at the facial level, and systemic corticoid treatment was not demonstrated. A Danish studio established a correlation between atopic dermatitis and cataracts that especially applies to patients under 50 [ 52 , 53 ].…”