Ophthalmology. Retina · 2026
Pediatric Uveitic Macular Edema in Noninfectious Uveitis: Structural and Visual Outcomes and Predictors of Visual Prognosis.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Feo Alessandro, Pillar Shani, Forte Paolo, Quarta Alberto, Yun Justin S, Patel Anamika, Popovic Marko M, Tran Kelly K, Tsui Edmund
Аннотация
PURPOSE: To characterize the clinical features, imaging findings, and long-term visual and structural outcomes of pediatric uveitic macular edema (UME) and to identify longitudinal predictors of visual prognosis.
DESIGN: Retrospective observational cohort study.
PARTICIPANTS: Thirty-one eyes of 20 pediatric patients with noninfectious uveitis complicated by UME treated at a tertiary referral center.
METHODS: Medical records of children with UME were retrospectively reviewed. Baseline was defined as the first visit demonstrating intraretinal cysts on OCT. Clinical, imaging, and treatment data were collected at baseline; visits closest to 3, 6, and 12 months; and at the last available follow-up. OCT parameters included central macular thickness (CMT), subfoveal choroidal thickness, intraretinal fluid (IRF), subretinal fluid (SRF), intraretinal hyperreflective foci, disorganization of the retinal inner layers, and ellipsoid zone/external limiting membrane (EZ/ELM) disruption. Longitudinal outcomes were analyzed using linear mixed-effects models accounting for intereye correlation.
MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA), OCT structural changes, inflammatory control, treatment patterns, and predictors of BCVA at 12 months.
RESULTS: Median age at baseline was 13 years (interquartile range [IQR], 9-14), with a median follow-up of 3.2 years (IQR, 1.5-4.5). Median BCVA improved from 0.4 logarithm of the minimum angle of resolution (logMAR) (20/50; IQR, 0.18-0.88) at baseline to 0.18 logMAR (20/30; IQR, 0-0.51) at final follow-up (P = 0.002). Median CMT significantly decreased from 422 μm (IQR, 350-532) at baseline to 292 μm (IQR, 264-328) at the last follow-up (P < 0.001). The proportion of eyes with IRF declined from 100% (31/31) at baseline to 19.2% (5/31) at final follow-up, and SRF resolved in all eyes from 6 months onward (P < 0.001). Inflammatory activity decreased significantly over time. Use of immunomodulatory therapy increased from 30% at baseline to 90% at final follow-up (P < 0.001), whereas systemic corticosteroid use progressively declined. In multivariable analysis, worse BCVA (P < 0.001) and EZ/ELM disruption (P = 0.006) during early follow-up independently predicted worse BCVA at 12 months.
CONCLUSIONS: Pediatric UME demonstrates substantial anatomic improvement and stabilization of visual function under contemporary immunomodulatory strategies. Early BCVA and photoreceptor layer integrity (EZ/ELM) were associated with visual outcomes and may help identify children at risk for poorer prognosis requiring earlier therapeutic escalation.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: Retrospective observational cohort study.
PARTICIPANTS: Thirty-one eyes of 20 pediatric patients with noninfectious uveitis complicated by UME treated at a tertiary referral center.
METHODS: Medical records of children with UME were retrospectively reviewed. Baseline was defined as the first visit demonstrating intraretinal cysts on OCT. Clinical, imaging, and treatment data were collected at baseline; visits closest to 3, 6, and 12 months; and at the last available follow-up. OCT parameters included central macular thickness (CMT), subfoveal choroidal thickness, intraretinal fluid (IRF), subretinal fluid (SRF), intraretinal hyperreflective foci, disorganization of the retinal inner layers, and ellipsoid zone/external limiting membrane (EZ/ELM) disruption. Longitudinal outcomes were analyzed using linear mixed-effects models accounting for intereye correlation.
MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA), OCT structural changes, inflammatory control, treatment patterns, and predictors of BCVA at 12 months.
RESULTS: Median age at baseline was 13 years (interquartile range [IQR], 9-14), with a median follow-up of 3.2 years (IQR, 1.5-4.5). Median BCVA improved from 0.4 logarithm of the minimum angle of resolution (logMAR) (20/50; IQR, 0.18-0.88) at baseline to 0.18 logMAR (20/30; IQR, 0-0.51) at final follow-up (P = 0.002). Median CMT significantly decreased from 422 μm (IQR, 350-532) at baseline to 292 μm (IQR, 264-328) at the last follow-up (P < 0.001). The proportion of eyes with IRF declined from 100% (31/31) at baseline to 19.2% (5/31) at final follow-up, and SRF resolved in all eyes from 6 months onward (P < 0.001). Inflammatory activity decreased significantly over time. Use of immunomodulatory therapy increased from 30% at baseline to 90% at final follow-up (P < 0.001), whereas systemic corticosteroid use progressively declined. In multivariable analysis, worse BCVA (P < 0.001) and EZ/ELM disruption (P = 0.006) during early follow-up independently predicted worse BCVA at 12 months.
CONCLUSIONS: Pediatric UME demonstrates substantial anatomic improvement and stabilization of visual function under contemporary immunomodulatory strategies. Early BCVA and photoreceptor layer integrity (EZ/ELM) were associated with visual outcomes and may help identify children at risk for poorer prognosis requiring earlier therapeutic escalation.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.