A 10-year review of pediatric uveitis at a Hispanic-dominated tertiary pediatric ophthalmic clinic

Patterns and Outcomes of Pediatric Uveitis in a University-Based Tertiary Referral Center in Riyadh, Saudi Arabia

PURPOSE

To investigate the patterns and outcomes of pediatric uveitis.

METHODS

Retrospective review of patients with uveitis in pediatric age group.

RESULTS

A total of 184 patients (335 eyes) were included. There were 96 (52.2%) boys and 88 (47.8%) girls, with a mean age of 12.8 ± 3.4 years at presentation. Panuveitis was most common (55.2%), followed by anterior uveitis (29.6%), intermediate uveitis (12.2%) and posterior uveitis (3%). Uveitis was non-granulomatous in 71% and non-infectious in 94.6% of the eyes. The most identifiable specific diagnoses were Vogt-Koyanagi-Harada (VKH) disease (21.2%), juvenile idiopathic arthritis (6.5%), sarcoidosis (4.3%), and presumed tuberculous uveitis (3.3%). After 1-year follow-up, 85.4% of the eyes achieved visual acuity of 20/40 or better.

CONCLUSIONS

The most common anatomic diagnosis was panuveitis. VKH disease was the most frequently diagnosed entity.

Social Determinants of Health in Uveitis: A Literature Review

BACKGROUND

The uveitides are a group of intraocular inflammatory diseases which can lead to blindness without treatment. It has been shown that socioeconomic status, health literacy, and access to healthcare play a pivotal role in the prevalence, severity, and treatment outcomes in ophthalmic conditions. We review the current literature on the impact of social determinants of health (SDoH) in patients with uveitis.

METHODS

A systematic literature search was conducted utilizing PubMed, Google Scholar, and Embase databases in July 2024. Inclusion criteria included studies written in English, focusing on SDoH in patients with uveitis using the following keywords: "uveitis," "social determinants of health," "socioeconomic status," "education," "access to healthcare," "health literacy," "health disparities," "race/ethnicity," "gender," and "environmental factors." Case reports were excluded.

RESULTS

Fifty two articles were included. Among these, 31 addressed healthcare access (e.g. limited specialist availability, cost/insurance barriers, urban-rural gaps), 23 highlighted economic stability (e.g. low income, out-of-pocket costs, poor medication adherence), 19 discussed environment and community (e.g. higher infectious uveitis rates in resource-limited areas, lack of social support), 18 focused on racial and ethnic disparities (e.g. advanced disease at presentation, worse outcomes for African American, Hispanic, and Indigenous populations), and 15 addressed education and awareness (e.g. low health literacy, inadequate patient education materials). Nine papers examined two domains, and 10 incorporated three or more. Across domains, limited resources and knowledge were associated with delayed diagnosis, suboptimal adherence, and poorer visual outcomes.

CONCLUSION

The current literature shows a correlation between SDoH and an increased incidence and poorer disease outcomes in patients with uveitis. Further research is needed to mitigate disparities in care for patients with uveitis.

Demographic and Clinical Profile of Pediatric Uveitis in Delta Region, Egypt

PURPOSE

Pediatric uveitis poses unique challenges, characterized by difficulties in performing comprehensive examinations, potential delays in diagnosis, and a heightened risk of ocular complications. This study evaluate the etiologic and clinical characteristics of uveitis in children presenting to the Mansoura Ophthalmic Center, Mansoura, Egypt.

METHODS

A cross-sectional observational study was undertaken involving children diagnosed with uveitis attending the uveitis outpatient clinic at Mansoura University Ophthalmic Center. Comprehensive clinical evaluations were carried out, including detailed history taking and exhaustive ophthalmological examinations. Whenever deemed necessary, Spectral Domain Optical Coherence Tomography (OCT) and Fluorescein Fundus Angiography (FFA) were utilized to secure retinal images. An extensive systemic evaluation was also conducted to discern the diverse causes of uveitis among the participants.

RESULTS

The cohort comprised 63 children, impacting 97 eyes. Bilateral involvement was seen in 54% of cases, with a male predominance of 58.7%. The predominant etiologies of uveitis were presumed trematode-induced (36.7%), Juvenile Idiopathic Arthritis (JIA) accounting for 28.6%, and in 12.7% of cases, the cause remained undetermined. Anterior uveitis emerged as the primary presentation in 79.4% of cases. Regarding visual loss, cataract was the leading cause at 56.4%, followed by vitritis at 38.4%, and macular edema at 20.5%.

CONCLUSION

Anterior uveitis was the most frequent presentation in our pediatric cohort. Despite the challenges, the majority of children with uveitis exhibited no significant visual impairment, with most causes of visual loss being reversible.

Clinical profile and treatment outcomes in pediatric uveitis - A series from South India

PURPOSE

The purpose of the study was to look at the clinical spectrum, treatment options, and visual outcomes in a large cohort of pediatric uveitis from a tertiary eye care center in South India.

METHODS

This is a retrospective study carried out at a tertiary eye center in South India. Cases of pediatric uveitis between January 2012 and June 2022 were retrieved from the hospital's medical database. Uveitis was classified according to the Standardization of Uveitis Nomenclature criteria. Demographic details, clinical presentation, complications, medical and surgical management, and visual outcome were evaluated.

RESULTS

Two hundred and six eyes of 132 cases were included, with a median age of 12 years. The male to female ratio was 1:1. Bilaterality was seen in 63.1% of cases. The mean duration of uveitis was 11.5 ± 18.5 months, and the mean follow-up period was 20.5 ± 25.1 months. Noninfectious uveitis was seen in 70.45% cases. Most common etiology in the noninfectious group was idiopathic (27.3%), while in the infectious group, it was tuberculosis (TB; 14.4%). Immunomodulators were used in 43.9% and biologics in 10.9% of cases. Most common complications were cataract (25.24%) and posterior synechiae (21.35%). Surgical procedures were done in 12.62%. The mean visual acuity was 0.81 ± 1.14 log of minimum angle of resolution (logMAR) at presentation and 0.49 ± 0.87 logMAR at the end of the study ( P = 0.002).

CONCLUSION

Pediatric uveitis poses a challenge in comparison to adult uveitis. Our study highlights the need for early diagnosis and aggressive management to prevent sequelae. Multidisciplinary approach is a key in improving the overall visual prognosis.

Epidemiology of Pediatric Uveitis in Argentina

PURPOSE

To explore the geographic variability of the epidemiology of pediatric uveitis, which, although rare in children, carries a significant risk of morbidity.

METHODS

This was a retrospective review conducted at two tertiary referral centers in Buenos Aires, Argentina. Demographic and clinical data of patients younger than 16 years diagnosed as having uveitis between January 1, 2006 and October 1, 2014 were collected.

RESULTS

A total of 257 patients (380 eyes) were included in the study. Cases tended to be unilateral (134, 52.1%), granulomatous (146, 56.8%), and localized to the posterior segment (121, 47.1%). Toxoplasmosis was the most common etiology (98, 38.1%).

DISCUSSION

The spectrum of pediatric uveitis in Buenos Aires most closely resembles that of Colombia. Understanding these geographic variations is important to aid providers who are caring for children in an increasingly globalized world. [J Pediatr Ophthalmol Strabismus. 2024;61(3):183-187.].

Epidemiology of Pediatric Uveitis

Uveitis is uncommon in children and its diagnosis and treatment are challenging. Little is known of the epidemiology of pediatric uveitis. Indeed, population-based studies in the literature are rare. However, there are many tertiary referral center reports that describe the patterns of uveitis in childhood, although few are from developed countries, and their comparison presents some issues. Anterior uveitis is the most frequent entity worldwide, especially in Western countries, where juvenile idiopathic arthritis is diffuse. Most cases of intermediate uveitis do not show any association with infectious or noninfectious systemic diseases. In low- and middle-income countries, posterior uveitis and panuveitis are prevalent due to the higher rates of infectious etiologies and systemic diseases such as Behçet disease and Vogt-Koyanagi-Harada disease. In recent decades, idiopathic uveitis rate has decreased thanks to diagnostic improvements.

Long-term visual acuity outcome of pediatric uveitis patients presenting with severe visual impairment

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.

Uveitis in children: Epidemiological, clinical and prognostic characteristics

PURPOSE

The purpose of this study is to describe the characteristics and prognostic factors of pediatric uveitis in a French university referral hospital.

METHODS

We performed a retrospective study of all cases of all pediatric uveitis seen at our institution over a 7-year period.

RESULTS

A total of 141 eyes of 86 children were included. The mean age was 10.7 years, and 61.6% were girls. The uveitis was bilateral in 64.0% of cases. Anterior uveitis (41.0%) and intermediate uveitis (32.0%) were the most frequent forms. The most frequent etiologies were idiopathic (27.9%), juvenile idiopathic arthritis (25.6%) and pars planitis (18.6%). During the follow-up period, systemic corticosteroids were received by 43.0% of children, immunosuppressive drugs by 31.4% and biological agents by 18.6%. At the final examination, complications were present in 67.0% of patients: 18.0% had cataracts, and 11.3% had intraocular hypertension. Posterior synechiae were present in 27.6% of eyes, optic disc edema in 10.5% and macular edema in 16.2%. At the last visit, visual acuity was better than 20/200 in 97.0% of cases. The presence of band keratopathy, cataract or glaucoma was an independent predictor of impaired visual outcomes at follow-up.

CONCLUSION

Juvenile idiopathic arthritis is one of the most frequent and severe pediatric uveitides. Close monitoring and early treatment could prevent complications.

The Pattern of Uveitis in a Pediatric Population at a Tertiary Center in Thailand

PURPOSE

To describe the clinical characteristics and longitudinal pattern of visual acuity (VA) of pediatric patients with uveitis at a tertiary center in Thailand.

METHODS

We retrospectively reviewed the records of children with uveitis ≤16 years who presented to the clinic between January 2010 and June 2020.

RESULTS

The mean age at onset was 9.1(±4.3) years; the main characteristics were chronic (64.4%), unilateral (68.6%), and panuveitis (39%). The common etiologies were ocular toxoplasmosis (11.9%), herpetic uveitis (10.2%), and ocular toxocariasis (6.8%). Further, 40% of the eyes presented with VA of ≤20/200; mean VA at baseline improved from 0.93 to 0.72 logMAR at 3 months after presentation (P < .001), the baseline VA of ≤20/200 was significantly associated with poor VA outcome at 1 year.

CONCLUSION

Chronic, unilateral, and panuveitis represented the majority of our children with uveitis. Infectious etiology was common. Significant VA improvement can be achieved with optimum management.

Intermediate Uveitis Etiology, Complications, Treatment, and Outcomes in a Colombian Uveitis Referral Center

Purpose

To analyze the etiology, clinical characteristics, complications, treatments, and outcomes of patients with intermediate uveitis examined in a uveitis referral center in Bogotá, Colombia.

Patients and Methods

We conducted a retrospective descriptive study. We reviewed systematically the clinical records of patients attending a uveitis referral center in Bogotá, Colombia from 2013 to 2020. Data analysis included demographics, etiology, clinical characteristics, treatment modalities, best-corrected visual acuity, and complications. For categorical variables, absolute and relative frequencies were used while for continuous variables mean and standard deviations were calculated.

Results

We identified 18 patients with intermediate uveitis. The mean age at disease onset was 19.4 years. There was no sex predominance. Two-thirds of the patients presented bilateral involvement. The mean initial best-corrected visual acuity was 0.19 LogMAR. The most common etiology was idiopathic followed by undetermined, tuberculosis, multiple sclerosis, and juvenile idiopathic arthritis. The most common characteristics were insidious onset, chronic course, and persistent duration. The complications found were macular edema, optic disk edema, cataract, epiretinal membrane, among others. Corticosteroids and immunosuppressive therapy were the most common treatments. Mean follow-up time was 24.4 months, and the mean final best-corrected visual acuity was 0.12 LogMAR.

Conclusion

This is the first study describing intermediate uveitis features in South America. In our context, intermediate uveitis is infrequent. Polyautoimmunity and familial autoimmunity phenomena were found in some patients. These may require a multidisciplinary approach. Ophthalmologists should promptly diagnose, treat, and refer patients with this disease to avoid common complications. Further studies are required to determine the disease relation with polyautoimmunity.

Comparison of pediatric patients with noninfectious idiopathic uveitis and noninfectious uveitis associated with an underlying systemic disease: from a referral center in Turkey

Aim: The aim of this study was to determine the demographic, clinical, treatment, and outcome features of pediatric noninfectious uveitis patients at a Turkish tertiary center.Materials and methods: This retrospective cohort study included 101 pediatric patients with noninfectious uveitis. Location of uveitis, laterality, age at onset of uveitis, complications of uveitis, duration of follow-up, associated systemic diseases, laboratory findings, medications used, and status of uveitis at the time of data collection were obtained from the patients' files. The patients were divided into two groups according to etiology of uveitis, as follows; group 1: idiopathic noninfectious uveitis; group 2: noninfectious uveitis in association with an underlying systemic disease. Clinical findings were compared between the two groups.Results: Mean age at diagnosis of uveitis was 9.36 ± 4.24 years and mean duration of follow-up was 48.4 ± 9.2 months. Anterior uveitis was the most common form, accounting for 69.3% (n = 70) of the patients. There were 67 (66.3%) patients in group 1 and 34 (33.7%) patients in group 2. Mean age at diagnosis of uveitis was lower in group 2 (p < 0.05). Although gender, type of inflammation, laterality of eye involvement, and mean age at initiation of biological treatment did not differ between the groups; symptomatic uveitis was more common in group 1, whereas anterior uveitis was also more common in group 2 (p < 0.05). At the time of data collection 16 (15.8%) of the patients had active uveitis. Ocular complications were observed fewer in idiopathic noninfectious uveitis group than noninfectious uveitis associated with an underlying systemic disease (p < 0.05). Biological therapy was administered in 26.8% of the patients in group 1, versus 67.6% of those in group 2. Ocular complications were observed in 22.8% of the patients at presentation or during the follow-up.Conclusion: Herein a large retrospective cohort of noninfectious pediatric uveitis has been described. The findings indicate that noninfectious idiopathic uveitis is characterized by more symptomatic, later onset, and fewer complications than noninfectious uveitis associated with an underlying systemic disease.

Clinical features of childhood uveitis at a tertiary referral center in Southern Turkey

PURPOSE

To report the epidemiology, etiology, ocular characteristics, management, and visual outcomes of pediatric uveitis patients in Southern Turkey.

METHODS

The clinical records of pediatric patients with a diagnosis of uveitis under the age of 16 years and followed up longer than 6 months were analyzed retrospectively.

RESULTS

The study included 102 patients and 173 affected eyes. The mean age at presentation was 11.4 ± 3.7 years. Uveitis was predominantly bilateral (69.6%), anterior (45.1%), and chronic (58.8%). The leading diagnoses were idiopathic uveitis (38.2%), pars planitis (19.6%), and juvenile idiopathic arthritis-associated uveitis (14.7%). Infectious uveitis accounted for 12.7%, and toxoplasmosis was the most common cause (10.8%). At least one complication was observed in 76.3% of the eyes, and optic disk edema (37%) was the most frequent. Corticosteroids were used in 97.1% and systemic immunomodulatory agents in 49% of the patients. Ocular surgery was performed in 17.3% of the eyes, and cataract extraction was the most common (8.7%). The mean BCVA was 0.39 ± 0.66 LogMAR at baseline and 0.25 ± 0.53 LogMAR at the last recorded visit.

CONCLUSION

Pediatric uveitis is a challenging disease that requires meticulous management. Anterior uveitis is the most frequent form. Despite a changing trend for an increase in diagnostic variety, idiopathic cases still constitute the majority. A significant number of patients receive systemic therapy, develop complications, and require surgical intervention. Early diagnosis and appropriate treatment might improve visual outcomes and reduce the risk of visual loss.

M, Dubey N. Pediatric uveitis: a retrospective analysis at a tertiary eye care hospital in South India

PURPOSE

To analyze the demographics, etiology, complications, treatment modalities, and visual outcomes in pediatric uveitis patients at a tertiary eye care hospital.

METHODS

A retrospective review of medical records of pediatric uveitis patients who presented with us from January 2014 to January 2020 was evaluated.

RESULTS

Out of the 178 pediatric uveitis patients, 65 children were included in the study. The most common age group was 6-10 years (46%). Of the included patients, 36 (55.4%) were male and 29 (44.6%) were female. Presentation was bilateral in 39 (60%) and unilateral in 26 (40%). Anterior uveitis was seen in 19 (29.23%), intermediate in 18 (27.69%), posterior in 16 (24.62%), and panuveitis in 12 (18.46%) patients. There were 2 cases of masquerades. Non-infectious uveitis was the most commonly seen, in 48 (73.84%) of total cases, among which 21 (43.75%) were idiopathic and 7 (14.58%) were associated with juvenile idiopathic (JIA) arthritis. Infectious uveitis was present in 17 (26.15%); the most common etiology was toxoplasmosis. Baseline visual acuity was low in 22 (33.84%) children. After initiating treatment, 37 (56.92%) showed improvement in vision and 10 (15.38%) had worsening of vision. Intraocular pressure (IOP) rise was seen in 5 (7.69%) children; 51 (78.46%) children required medical management and 16 (24.61%) children required surgical intervention; 46 (70.76%) children had uveitis related complications out of which most of them 30 (65.21%) were present at baseline.

CONCLUSIONS

Anterior and intermediate uveitis were the most common types observed in our study. Toxoplasmosis was the most common type of infectious uveitis and JIA the most common cause in non-infectious type apart from idiopathic uveitis. Posterior uveitis had low visual acuity at baseline and follow-up. Children presented to us with poor visual acuity and complications at baseline, hence an early referral to a tertiary eye hospital and management accordingly can improve the quality of vision and visual rehabilitation.

Association of toll-like receptor 10 polymorphisms with paediatric idiopathic uveitis in Han Chinese

AIMS

We aimed to determine whether paediatric idiopathic uveitis (PIU) and juvenile idiopathic arthritis associated paediatric uveitis (JIA-PU) have an association with Toll-like receptor 10 (TLR10) gene polymorphisms in Han Chinese.

METHODS

Ten tag single nucleotide polymorphisms (SNPs) of TLR10 were analysed in 992 PIU patients, 127 JIA-PU patients and 1600 controls using the Sequenom MassARRAY system and iPLEX Gold assay. Genotype and allele frequencies were analysed using the χ2 test. A stratified analysis was performed according to the clinical features of PIU.

RESULTS

Increased frequencies of the rs2101521 A allele, rs10004195 A allele, rs11725309 CC genotype and rs6841698 AA genotype were found in PIU patients compared with controls (corrected p values (Pc)=1.81×10^-4, Pc= 1.12×10^-2, Pc=2.41×10^-2 and Pc=3.29×10^-3, respectively). There was no association between these 10 tag SNPs and JIA-PU. In the stratified analysis, the frequency of the rs6841698 A allele was higher in PIU patients with cataract (Pc=1.45×10^-6). The frequencies of the rs2101521 A allele and rs6841698 AA genotype were increased in PIU patients with band keratopathy (BK) (Pc=2.32×10^-2, Pc=3.30×10^-3, respectively).

CONCLUSION

TLR10 gene polymorphisms (rs2101521, rs10004195, rs11725309 and rs6841698) confer susceptibility to PIU in Han Chinese. In a stratified analysis, rs2101521 and rs6841698 are associated with PIU with BK, and rs6841698 correlates with PIU with cataract.

Genetic aspects of idiopathic paediatric uveitis and juvenile idiopathic arthritis associated uveitis in Chinese Han

Background

Idiopathic paediatric uveitis (IPU) and juvenile idiopathic arthritis associated uveitis (JIA-U) are the two most common entities in paediatric uveitis. This study addressed the possible association of IPU and JIA-U with genes that had been shown earlier to be associated with juvenile idiopathic arthritis.

Methods

We carried out a case-control association study involving 286 IPU, 134 JIA-U patients and 743 healthy individuals. A total of 84 candidate single nucleotide polymorphisms (SNPs) in 60 genes were selected for this study. The MassARRAY platform and iPLEX Gold Genotyping Assay was used to genotype 83 candidate SNPs and the remaining SNP (rs27293) was analysed using the TaqMan SNP Genotyping Assay.

Results

No evidence was found for an association of the candidate polymorphisms tested with IPU. Six SNPs (PRM1/rs11074967, JAZF1/rs73300638, IRF5/rs2004640, MEFV/rs224217, PSMA3/rs2348071 and PTPN2/rs7234029) showed an association with JIA-U (p<1.0×10⁻²).

Conclusion

Our findings showed associations of six SNPs (PRM1/rs11074967, JAZF1/rs73300638, IRF5/rs2004640, MEFV/rs224217, PSMA3/rs2348071 and PTPN2/rs7234029) with JIA-U. No association was detected between the 84 tested SNPs and IPU.

The Challenge of Pediatric Uveitis: Tertiary Referral Center Experience in the United States

Purpose: To describe the distribution, clinical findings, visual outcomes, treatment, and complications of children with uveitis at a tertiary referral ophthalmic center. Methods: Retrospective cohort study. We reviewed the medical records of all patients ≤16 years with uveitis referred to Massachusetts Eye Research and Surgery Institution from March 2005 to July 2016. Results: Of 286 included children, 62.24% were female. Mean age of onset was 8.4 years. The uveitis was mainly anterior (61.9%), recurrent (68.53%), bilateral (81.82%), and noninfectious (96.5%). Idiopathic cases accounted for 51.4%. The most frequent systemic association was juvenile idiopathic arthritis (34.96%). The majority of patients (78.32%) experienced complications. All patients, except one, needed systemic therapy. Conclusion: Pediatric uveitis is challenging to diagnose and manage, with frequent and potentially severe complications. Most cases were bilateral, recurrent, and idiopathic. Prompt referral to uveitis-specialized centers and an appropriate systemic therapy are mandatory for good visual outcomes.

Management of cataract in uveitis patients

PURPOSE OF REVIEW

This review is timely because the outcomes of surgical invention in uveitic eyes with cataract can be optimized with adherence to strict anti-inflammatory principles.

RECENT FINDINGS

All eyes should be free of any cell/ flare for a minimum of 3 months preoperatively. Another helpful maneuver is to place dexamethasone in the infusion fluid or triamcinolone intracamerally at the end of surgery. Recent reports about the choice of intraocular lens material or lens design are germane to the best surgical outcome. Integrating these findings will promote better visual outcomes and allow advancement in research to further refine these surgical interventions in high-risk uveitic eyes.

SUMMARY

Control of inflammation has been shown to greatly improve postoperative outcomes in patients with uveitis. Despite better outcomes, more scientific research needs to be done regarding lens placement and materials and further research needs to adhere to the standardized reporting of uveitis nomenclature. Future studies should improve postoperative outcomes in eyes with uveitis so that they approach those of eyes undergoing routine cataract procedures.