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Long-term visual acuity outcome of pediatric uveitis patients presenting with severe visual impairment
Usanee Tungsattayathitthan1, Narisa Rattanalert1, Wantanee Sittivarakul2
1Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, 90110, Songkhla, Thailand.
Insights
Children with severe visual impairment from uveitis often have poor long-term vision outcomes. Early diagnosis and treatment are crucial for better visual acuity (VA) in pediatric uveitis cases.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Immunology
Background:
- Uveitis in children can lead to severe visual impairment (SVI).
- Long-term visual acuity (VA) outcomes for pediatric uveitis with SVI at presentation are not well-established.
- Understanding predictive factors for VA outcomes is crucial for management.
Purpose of the Study:
- To investigate the long-term visual acuity (VA) outcome in children with uveitis and severe visual impairment (SVI) at presentation.
- To identify factors associated with VA improvement or decline over time.
Main Methods:
- Retrospective review of 57 eyes of 51 children (≤16 years) with uveitis and SVI (VA ≤ 20/200) managed between 2010-2020.
- Analysis of clinical data, including uveitis type, diagnosis, complications, and VA measurements at presentation and follow-up.
- Statistical analysis to identify predictive factors for VA outcomes.
Main Results:
- The mean logMAR VA improved from 1.8 at presentation to 1.2 at 5 years (P < 0.001).
- Ocular complications were present in 93% of eyes at presentation.
- Factors predicting poorer VA outcome included preschool age of onset, delayed diagnosis (≥1 month symptom duration), and non-anterior uveitis.
Conclusions:
- Long-term visual acuity outcomes for pediatric uveitis with SVI at presentation are generally unfavorable.
- Younger age at onset, delayed presentation, and posterior segment involvement are associated with poorer visual outcomes.
- Aggressive management and early intervention are critical for improving visual prognosis in pediatric uveitis.
Abstract:
This study investigated the long-term visual acuity (VA) outcome in the eyes of children with uveitis and severe visual impairment (SVI; VA ≤ 20/200) at presentation. Fifty-one children [57 eyes; median age, 11 years; 51% female; median follow-up period, 36 months (interquartile range 14.9-64.4)] aged ≤ 16 years with uveitis managed at our tertiary center from January 2010 to July 2020 were reviewed. Uveitis mainly manifested as unilateral (74.5%), chronic course (82.4%), and panuveitis (43.1%). Ocular toxoplasmosis and toxocariasis were the most common diagnoses (9.8% each). At least one ocular complication at presentation was observed in 93% of the eyes. Overall, the mean logMAR VA improved from 1.8 at presentation to 1.2 at 5 years (P < 0.001). Common causes of poor vision included retinal detachment, atrophic bulbi, and optic atrophy. Predictive factors associated with less VA improvement over the follow-up period included preschool age of uveitis onset (P < 0.001), ocular symptoms duration before uveitis diagnosis ≥ 1 month (P = 0.004), and non-anterior uveitis (P = 0.047). The long-term VA outcome in uveitis-affected eyes with SVI at presentation was unfavorable. Younger age at uveitis onset, delayed presentation, and uveitis involving the posterior segment were associated with poorer VA outcome.
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