Young age as a risk factor for complicated course and visual outcome in intermediate uveitis in children.
Résumé
Objective: To identify prognostic factors in intermediate uveitis (IU) in children. Methods: Retrospective case series of 35 patients with onset of IU ≤ 16 years and a minimum follow-up of 1 year. Demographic and numerous clinical data were documented. Visual outcomes and development of complications were analyzed in relation to age of onset and ocular signs at presentation. Results: Forty-six percent of patients had onset ≤7 years and in 54% >7 years. The younger onset group had shorter event-free survival for secondary glaucoma (p=0.04) and vitreous hemorrhage (p=0.01). Mean age of onset in children with cataract (5.9 versus 8.7 years), glaucoma (5.0 versus 8.4) and vitreous hemorrhage (5.6 versus 8.5) was lower then in children without these complications (all p=0.03). Frequencies of other complications did not differ between both groups. The younger onset group had worse BCVA's at presentation (0.3 versus 0.6), at 1 year (0.4 versus 0.9) and at 3 years follow-up (0.6 versus 0.9; all p≤0.04) and they needed longer treatment (p=0.01). Children with young onset of IU reached remission less frequently (p=0.05). Development of cystoid macular edema (CME) was independently associated with papillitis (adjusted HR=3.4; p=0.02) and snowbanking (adjusted HR=3.3; p=0.03) at presentation. Other complications at onset were not predictive for future complications. Conclusions: Children with young onset of IU carry higher risk of complications and worse visual outcome. We would recommend considering more intensive monitoring and earlier threshold for systemic treatment in those children with risk factors as early onset, papillitis and/or snowbanking at initial presentation.
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