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Visual loss associated with pediatric uveitis in english primary and referral centers
Clive Edelsten1, M Ashwin Reddy, Miles R Stanford
1Medical Ophthalmology Department, Great Ormond Street Hospital, London, United Kingdom. edelsten@easynet.co.uk
Insights
Pediatric uveitis patterns differ between primary and referral centers. While idiopathic uveitis is common in district hospitals, referral centers see more juvenile idiopathic arthritis-associated uveitis, impacting visual loss rates.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Rheumatology
Background:
- Pediatric uveitis is a rare condition associated with significant visual loss.
- Previous studies on pediatric uveitis have been limited, with unclear referral bias effects.
- Understanding disease patterns in primary versus referral settings is crucial for effective management.
Purpose of the Study:
- To examine the distinct characteristics of pediatric uveitis in primary and referral centers.
- To identify age-related differences in uveitis types and associated systemic diseases in children.
- To determine factors contributing to visual loss in pediatric uveitis patients.
Main Methods:
- A retrospective, multicenter, observational study involving 249 pediatric uveitis patients (onset before age 20).
- Data collected from three primary and two referral ophthalmic units.
- Analysis of age-related differences, systemic associations, and visual loss predictors.
Main Results:
- Idiopathic uveitis was prevalent in district hospitals (78%), while juvenile idiopathic arthritis-associated uveitis dominated referral centers (67%).
- Age-specific patterns emerged: chronic anterior uveitis (0-7 years), posterior uveitis (8-15 years), and acute anterior uveitis (16-19 years).
- Visual loss occurred in 17% of patients, most frequently in posterior uveitis, and was significantly predicted by systemic treatment and surgical intervention.
Conclusions:
- Pediatric uveitis exhibits distinct etiological and clinical patterns based on healthcare setting.
- Age-specific uveitis types contribute to visual loss rates previously observed in children.
- Systemic treatment and surgery are critical factors influencing visual outcomes in pediatric uveitis.
Purpose:
Pediatric uveitis is rare and has been reported to cause increased rates of visual loss compared with adult patients. The reasons for this are unclear. Only one study has been population-based, so the effect of referral bias is not known. We examined the pattern of disease in primary and referral centers to establish the unique characteristics of uveitis in children.
Design:
Case control study.
Methods:
Retrospective, multicenter, observational study of uveitis starting before the age of 20 years. Two hundred forty-nine patients were recruited from three primary and two referral ophthalmic units. Age-related differences in types of uveitis and systemic disease between hospitals were characterized, as were associations with visual loss.
Results:
The incidence of uveitis in district hospitals at less than 16 years of age was 4.9/100,000: the most frequent diagnosis was idiopathic uveitis (78%). In referral cohorts the most frequent diagnosis was juvenile idiopathic arthritis-associated uveitis (67%). Other systemic diseases were rare. The most frequent type of uveitis at 0 to 7 years of age was chronic anterior uveitis, posterior uveitis in 8- to 15-year-olds, and acute anterior uveitis in 16- to 19-year-olds. Visual loss (any eye < 6/12) occurred in 17% and was not associated with age, sex, or hospital cohort. It was most frequent in posterior uveitis (25%). Treatment variables were independent predictors of visual loss: systemic treatment 2.2 (1.1- 4.6), surgical intervention 8.2 (3.8-17.6).
Conclusions:
Idiopathic uveitis was three times more common in district hospitals. Visual loss was similar to adult uveitis in this study. The increased frequency of severe chronic anterior uveitis in children aged 0 to 7 years and posterior uveitis in older children aged 8 to 15 years accounts for the rate of visual loss seen in previous studies.