Pediatric Uveitic Macular Edema in Noninfectious Uveitis: Structural and Visual Outcomes and Predictors of Visual Prognosis.

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.