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Changing patterns in uveitis of childhood
I Tugal-Tutkun1, K Havrlikova, W J Power
1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, 02114, USA.
Insights
Childhood uveitis, particularly that associated with juvenile rheumatoid arthritis (JRA), causes significant visual impairment. Early diagnosis and awareness of sight-threatening complications are crucial for better outcomes in pediatric uveitis patients.
Area of Science:
- Ophthalmology
- Pediatrics
- Rheumatology
Background:
- Childhood uveitis presents unique diagnostic and management challenges.
- Understanding disease patterns and morbidity is key to improving care for pediatric uveitis patients.
Purpose of the Study:
- To analyze the patterns, complications, treatments, and visual outcomes of uveitis in children.
- To identify leading causes and associated morbidities of pediatric uveitis.
Main Methods:
- Retrospective review of 130 patients with uveitis onset at age 16 or younger.
- Analysis of etiology, complications, treatments, and visual acuity outcomes.
Main Results:
- Juvenile rheumatoid arthritis (JRA)-associated uveitis was the most common cause (41.5%).
- Significant visual acuity loss (<20/200) was present in 26% at initial referral.
- JRA-associated uveitis led to high rates of cataract (71%), glaucoma (30%), and band keratopathy (66%).
Conclusions:
- Childhood uveitis is a serious condition with sight-threatening complications.
- JRA-associated uveitis is a primary cause of ocular morbidity in children.
- Increased physician awareness can lead to earlier diagnosis and improved treatment for pediatric uveitis.
Background:
Although uveitis is relatively uncommon in children, its diagnosis and management present a distinct clinical challenge for the physician. An improved knowledge of disease patterns and associated morbidity will help in the care of children with uveitis.
Methods:
The authors reviewed the records of 130 patients with onset of uveitis at 16 years of age or younger. The etiology of uveitis, complications encountered, treatment administered, and visual results were analyzed.
Results:
Uveitis associated with juvenile rheumatoid arthritis (JRA) was the largest group (41.5%) followed by idiopathic uveitis (21.5%) and pars planitis (15.3%). Twenty-six percent of the eyes had less than 20/200 visual acuity at the time of first referral. Patients with JRA had the highest rate of complications: cataract (71%), glaucoma (30%), band keratopathy (66%), and hypotony (19%). The most frequent complication of pars planitis was maculopathy (55%). Final visual acuity was less than 20/200 in 26% of eyes with JRA, 10.5% with pars planitis, and 14% with idiopathic uveitis.
Conclusion:
Uveitis beginning in childhood is a serious disease associated with sight-threatening complications. Juvenile rheumatoid arthritis-associated uveitis remains a leading cause of ocular morbidity in patients with childhood uveitis. Increased awareness by pediatricians, rheumatologists, and ophthalmologists of the seriousness of ocular complications of uveitis in childhood may lead to earlier diagnosis and more effective treatment regimens in the future.