Ocular complications in pediatric non-infectious anterior uveitis in long-term follow-up

Abstract

Background Pediatric uveitis is often asymptomatic, which may expose to sight-threatening ocular complications. The impact of modern medication on frequency of long-term ocular complications in pediatric patients with anterior idiopathic uveitis (IU) or juvenile idiopathic arthritis associated uveitis (JIA-U) is not fully understood. We aimed to evaluate the effect of modern treatment on ocular complications in the population-based cohort of children with anterior idiopathic uveitis (IU) or juvenile idiopathic arthritis associated uveitis (JIA-U). Methods A longitudinal, population-based cohort study of children with IU or JIA-U in 2008–2020. Variables assessed included age, gender, age at diagnosis, laterality, chronicity, vision, and ocular complications. Results 107 pediatric patients and 172 eyes with either IU (19 patients) or JIA-U (88 patients) were included. The mean age at uveitis onset was 10.0 ± 3.7 and 5.4 ± 3.2 years in IU and JIA-U, respectively (p < 0.001). Uveitis was chronic in 58% in IU and 74% in JIA-U patients, respectively. Uveitis was complicated with glaucoma in 45% of IU and 18% of JIA-U patients (p = 0.019). Cataract was developed in 31% of IU and 22% of JIA-U eyes (p = 0.28), and posterior synechiae in 21% and 9% of the eyes with IU and JIA-U, respectively. None of the eyes were hypotonic. Female gender was overrepresented in ocular complications. Glaucoma surgery was accomplished in 25 (15%) and cataract surgery in 19 (11%) eyes. Bilateral visual acuity remained > 0.5 in all patients. Conclusions Glaucoma, ocular hypertension, and cataract were the most typical complications of uveitis. Complications occurred mostly in girls and in IU patients. JIA-U patients with severe uveitis, young age at uveitis onset and female gender were predisposing factors for surgical management. Screening for JIA-U and modern treatment of uveitis has improved the prognosis of pediatric uveitis despite the development of ocular complications.