Incidence and Predictors of Ocular Complications in Pediatric-Onset Uveitis: Data from the AIDA Network Uveitis Registry.
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Gaggiano Carla, De-la-Torre Alejandra, Cardona-López Juanita, Guerriero Silvana, Ragab Gaafar, Paroli Maria Pia, Breda Luciana, Del Giudice Emanuela, Tarsia Maria, Sota Jurgen, Civino Adele, Cattalini Marco, Vitale Antonio, Gentileschi Stefano, Mauro Angela, Al-Mayouf Sulaiman, Hashad Soad, Fonollosa Alex, Aboul Naga Shereen Hassan, Amin Rana Hussein, Fotis Lampros, Gicchino Maria Francesca, Caggiano Valeria, Dammacco Rosanna, Maggio Maria Cristina, Rodríguez-Camelo Daniela, Chimenti Maria Sole, Lopez-Bonilla Juliana, Batu Ezgi Deniz, Ozen Seza, Minoia Francesca, Tufan Abdurrahman, Hegazy Mohamed Tharwat, Babu Kalpana, Sbalchiero Jessica, Moshrif Abdelhafeez, Barone Patrizia, Kawakami-Campos Perla Ayumi, Conforti Alessandro, Govoni Marcello, Conti Giovanni, Thabet Maissa, La Torre Francesco, Carreño Ester, Gupta Vishali, Frediani Bruno, Cantarini Luca, Fabiani Claudia, on behalf the AIDA Network
Аннотация
METHODS: This registry-based observational study included patients with noninfectious uveitis with disease onset < 18 years.
RESULTS: A total of 309 patients were enrolled (535 eyes). Uveitis was anterior in 290 eyes (54.2%), panuveitis in 121 (22.6%), intermediate in 88 (16.4%), and posterior in 24 (4.5%). Over a median follow-up of 49.0 months (interquartile range [IQR] 101.0), 137 children (44.3%) developed ≥ 1 complication (14.4 per 100 patient-years). Idiopathic uveitis (p < 0.001), longer topical glucocorticoid (GC) monotherapy (p < 0.001) and longer delay of immunosuppressive therapy (IST) (p = 0.03) were associated with a higher frequency of complications. In multivariate analysis, anterior uveitis was protective against complications (odds ratio [OR] 0.10, 95% confidence interval [CI] - 4.1 to - 1.6, p < 0.001), whereas a chronic course of uveitis significantly increased the risk (OR 6.13, 95% CI 1.0-2.6, p < 0.001). Older age at onset was protective against cataract (OR 0.91, 95% CI - 0.2 to - 0.02, p = 0.020) and band keratopathy (OR 0.8, 95% CI - 0.4 to - 0.1, p = 0.003). Final best-corrected visual acuity (BCVA) (Snellen decimals) was inversely correlated with the duration of topical GC monotherapy (ρ = - 0.23; p = 0.001). In multivariate analysis, panuveitis was linked to a 0.142 decimal reduction (95% CI - 0.219 to - 0.066, p < 0.001), and cataract to a 0.295 reduction (95% CI - 0.372 to - 0.217, p < 0.001) in the final BCVA.
CONCLUSIONS: Children with chronic, idiopathic, early-onset, and non-anterior uveitis are at greatest risk for complications. Structured screening for these children, along with early initiation of systemic IST, is essential to prevent visual impairment.