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The Risk of Intraocular Pressure Elevation in Pediatric Noninfectious Uveitis
Srishti Kothari1, C Stephen Foster2, Maxwell Pistilli3
1The Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts; Department of Ophthalmology, The Scheie Eye Institute, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Intraocular pressure (IOP) elevation affects many children with noninfectious uveitis. Key risk factors include corticosteroid use and contralateral eye issues, necessitating close monitoring in pediatric patients.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Inflammatory Diseases
Background:
- Noninfectious uveitis is a significant cause of vision loss in children.
- Intraocular pressure (IOP) elevation is a known complication, but risk factors in pediatric cases require further characterization.
Purpose of the Study:
- To identify the prevalence, incidence, and risk factors for intraocular pressure (IOP) elevation in children diagnosed with noninfectious uveitis.
Main Methods:
- A multicenter retrospective cohort study involving 916 children (1593 eyes) with noninfectious uveitis.
- Data collected via medical records review, focusing on IOP measurements and treatment history.
- Outcomes included IOP of 21 mmHg or more, 30 mmHg or more, and a 10 mmHg or more rise, considering IOP-lowering therapies.
Main Results:
- Initially, 15.8% of eyes had IOP ≥21 mmHg. Within 2 years, incidence rates for IOP elevation (≥21 mmHg, ≥30 mmHg, ≥10 mmHg rise) were 33.4%, 14.8%, and 24.4%, respectively.
- Significant risk factors for IOP elevation included age 6-12 years, prior ocular surgery, uveitis duration ≥6 months, contralateral IOP elevation, and corticosteroid use (dose- and route-dependent).
- Immunosuppressive therapy was not associated with increased IOP elevation risk.
Conclusions:
- Intraocular pressure elevation is a common complication in pediatric noninfectious uveitis.
- Corticosteroid use (dose- and route-dependent) and contralateral eye involvement are significant risk factors.
- Close monitoring for IOP elevation is crucial in pediatric uveitis patients, particularly those with identified risk factors.
Purpose:
To characterize the risk and risk factors for intraocular pressure (IOP) elevation in pediatric noninfectious uveitis.
Design:
Multicenter retrospective cohort study.
Participants:
Nine hundred sixteen children (1593 eyes) younger than 18 years at presentation with noninfectious uveitis followed up between January 1978 and December 2007 at 5 academic uveitis centers in the United States.
Methods:
Medical records review by trained, certified experts.
Main Outcome Measures:
Prevalence and incidence of IOP of 21 mmHg or more and 30 mmHg or more and incidence of a rise in IOP by 10 mmHg or more. To avoid underascertainment, outcomes were counted as present when IOP-lowering therapies were in use.
Results:
Initially, 251 (15.8%) and 46 eyes (2.9%) had IOP ≥21 mmHg and ≥30 mmHg, respectively. Factors significantly associated with presenting IOP elevation included age of 6 to 12 years (versus other pediatric ages), prior cataract surgery, pars plana vitrectomy, duration of uveitis ≥6 months, contralateral IOP elevation, presenting visual acuity worse than 20/40, and topical corticosteroid use (in a dose-response relationship). The median follow-up was 1.25 years (interquartile range, 0.4-3.66). The estimated incidence of any observed IOP elevation to ≥21 mmHg, to ≥30 mmHg, and increase in IOP by ≥10 mmHg was 33.4%, 14.8%, and 24.4%, respectively, within 2 years. Factors associated with IOP elevation included pars plana vitrectomy, contralateral IOP elevation (adjusted hazard ratio [aHR], up to 9.54; P < 0.001), and the use of topical (aHR, up to 8.77 that followed a dose-response relationship; P < 0.001), periocular (aHR, up to 7.96; P < 0.001), and intraocular (aHR, up to 19.7; P < 0.001) corticosteroids.
Conclusions:
Intraocular pressure elevation affects a large minority of children with noninfectious uveitis. Statistically significant risk factors include IOP elevation or use of IOP-lowering treatment in the contralateral eye and local corticosteroid use that demonstrated a dose-and route of administration-dependent relationship. In contrast, use of immunosuppressive drug therapy did not increase such risk. Pediatric eyes with noninfectious uveitis should be followed up closely for IOP elevation, especially when strong risk factors such as the use of local corticosteroids and contralateral IOP elevation are present.
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