Purpose

To describe the course of childhood-onset intermediate uveitis without associated systemic disease, and investigate determinants of outcomes.

Design

A retrospective clinical cohort study

Methods

This study was conducted in an institutional setting. A total of 125 children (221 eyes) aged 16 years and less participated. Outcomes of interest were visual acuity, severity of inflammation, and the occurrence of sight-threatening complications. Variables examined included age and clinical findings at presentation, treatment, and duration of follow-up. Multivariable analysis was undertaken to investigate potential predictors of outcomes.

Results

The median follow-up duration was 57 months. At presentation, best-corrected visual acuity worse than 20/160 was recorded in 11 (4.4%) eyes and significant vitreous haze (≥2+Standardisation of Uveitis Nomenclature (SUN)) in 35 (14%) eyes. Corticosteroid-sparing agents were used in 41 children (33%), with methotrexate most commonly used (27 children, 21.6%). The most frequent complications were raised intraocular pressure (n = 65; 29.4%), cataract (n = 41; 18.5%), and cystoid macular edema (n = 29; 13.1%). At the last visit, 116 (92.8%) patients achieved best-corrected vision of 20/40 or better with quiescent uveitis. The absence of the use of a steroid-sparing immunomodulatory agent was the strongest predictive factor for the development of new macular edema (odds ratio = 6.3, 95% CI = 2.3–16.9, P < .001) or glaucoma (odds ratio = 6.6, 95% CI = 2.5–17.9, P < .001) over the period of observation.

Conclusions

The visual outcomes of childhood-onset idiopathic intermediate uveitis are favorable. The frequency of sight-threatening sequelae of inflammation, which confer a lifelong risk of further visual loss, is high. The use of immunomodulatory therapy is associated with a lower risk of developing macular edema and ocular hypertension.

中文翻译：

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小儿特发性中间葡萄膜炎的长期结果

目的

描述没有相关全身性疾病的儿童期中间葡萄膜炎的病程，并调查结果的决定因素。

设计

回顾性临床队列研究

方法

这项研究是在机构环境中进行的。共有 125 名 16 岁及以下的儿童（221 只眼）参加。感兴趣的结果是视力、炎症的严重程度和威胁视力的并发症的发生。检查的变量包括年龄和临床表现、治疗和随访时间。进行多变量分析以调查结果的潜在预测因素。

结果

中位随访时间为 57 个月。就诊时，11 只 (4.4%) 眼的最佳矫正视力低于 20/160，35 只 (14%) 眼出现明显的玻璃体混浊（≥2+葡萄膜炎命名法标准化 (SUN)）。41 名儿童 (33%) 使用了皮质类固醇节约剂，最常用的是甲氨蝶呤 (27 名儿童，21.6%)。最常见的并发症是眼压升高（n = 65；29.4%）、白内障（n = 41；18.5%）和黄斑囊样水肿（n = 29；13.1%）。在最后一次就诊时，116 名 (92.8%) 静止性葡萄膜炎患者的最佳矫正视力达到 20/40 或更高。不使用类固醇免疫调节剂是新发黄斑水肿的最强预测因素（优势比 = 6.3，95% CI = 2.3-16.9，P< .001) 或青光眼 (优势比 = 6.6, 95% CI = 2.5–17.9, P < .001)。

结论

儿童期特发性中间葡萄膜炎的视觉结果是有利的。威胁视力的炎症后遗症的频率很高，这会导致终身进一步视力丧失的风险。免疫调节疗法的使用与发生黄斑水肿和高眼压症的风险降低有关。