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Intermediate uveitis in children and young adults: differences in clinical course, associations and visual outcome
Carsten Heinz1, Saskia Schoonbrood2, Arnd Heiligenhaus1
1Department of Ophthalmology, St. Franziskus-Hospital Muenster, Muenster, Germany Department of Ophthalmology, University of Duisburg- Essen, Germany.
Insights
Juvenile and adult intermediate uveitis (IU) share similar visual outcomes, though complications and associated diseases differ. This study highlights key differences in juvenile and adult-onset IU for better patient management.
Area of Science:
- Ophthalmology
- Immunology
- Systemic Diseases
Background:
- Intermediate uveitis (IU) poses a significant risk of vision loss and complications.
- Understanding the differences between juvenile-onset and adult-onset IU is crucial for effective management.
Purpose of the Study:
- To compare visual loss and complications in juvenile-onset IU versus adult-onset IU.
- To identify risk factors for poor visual acuity in different age groups.
Main Methods:
- Retrospective analysis of 110 children (≤16 years) and 107 young adults (17-35 years) with IU.
- Minimum follow-up of 1 year (mean 2.5 years).
Main Results:
- Similar best-corrected visual acuity (BCVA) at initial and final presentations between groups.
- Improved BCVA in 31% of children and 21% of adults; worsened in ~9% of both.
- Lyme disease (children) and multiple sclerosis (adults) were common associations. Cataract and macular edema were key complications in children; posterior synechiae, cataract, epiretinal membrane, and retinal detachment in adults.
Conclusions:
- Childhood and early adulthood onset IU demonstrate comparable visual trajectories over intermediate follow-up.
- Distinct patterns of associated systemic diseases and complications exist between pediatric and young adult IU patients.
Aim:
Intermediate uveitis (IU) is considered to carry a considerable risk for complications and visual loss. This study compares juvenile and adult onset IU with regard to visual loss and complications.
Methods:
Single-centre retrospective analysis of 110 consecutive children with onset of IU at the age of ≤16 years compared with 107 consecutive adult patients (17-35 years). All patients were followed for ≥1 year (mean 2.5±2.3 years).
Results:
Average age at first uveitis diagnosis in children (65 boys; 59%) was 9.7±3.17 years and in adults was 24.3±4.92 years (36 men; 34%; p=0.003). Best-corrected visual acuity (BCVA) in both groups was similar at first and last presentation. Compared with initial presentation, BCVA improved in 31% of children and 21% of adults during the follow-up period, while it worsened in 9% and 8.7%, respectively. Lyme disease in children (8%) and multiple sclerosis in adults (17%) were the most frequent systemic associations. Poor visual acuity at first presentation, snowbanks and vitreoretinal traction were associated with a higher risk for poor BCVA at last presentation. In children, cataract formation (OR 7.6; 95% CI 1.7 to 33.8) and macular oedema (13.6; 1.6 to 113.5) and in adults posterior synechiae (7.3; 1.8 to 30.2), cataract formation (19.02; 2.31 to 156.56), macular epiretinal membrane (5.1; 1.02 to 25.28) and retinal detachment (8.4; 1.4 to 51.2) were associated with poor BCVA during follow-up. Uveitis course was not worse if associated systemic disease was present.
Conclusions:
IU with onset in childhood and early adulthood showed a similar visual course at intermediate follow-up. Associated diseases and complication patterns differed between children and young adults.
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