Clinical outcomes of pediatric macular edema associated with non-infectious uveitis

Anh Hong Nguyen,Bethlehem Mekonnen,Eric Kim,Nisha R Acharya

doi:10.1186/s12348-021-00236-4

Anh Hong Nguyen, Bethlehem Mekonnen + Show 2 more

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https://doi.org/10.1186/s12348-021-00236-4

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Abstract

BackgroundMacular edema (ME) is the most frequent cause of irreversible visual impairment in patients with uveitis. To date, little data exists about the clinical course of ME in pediatric patients. A retrospective, observational study was performed to examine the visual and macular thickness outcomes of ME associated with chronic, noninfectious uveitis in pediatric patients.MethodsPediatric patients with noninfectious uveitis complicated by ME seen in the University of California San Francisco Health System from 2012 to 2018 were identified using ICD-9 and ICD-10 codes. Data were collected from medical records including demographics, diagnoses, ocular history, OCT imaging findings, complications, and treatments at first encounter and at 3, 6, 9, and 12-month follow-up visits. Cox proportional hazards regression was used to investigate the association between different classes of treatment (steroid drops, steroid injections, oral steroids and other immunosuppressive therapies) and resolution of macular edema.ResultsThe cohort comprised of 21 children (26 eyes) with a mean age of 10.5 years (SD 3.3). Undifferentiated uveitis was the most common diagnosis, affecting 19 eyes (73.1%). The majority of observed macular edema was unilateral (16 patients, 76.2%) and 5 patients had bilateral macular edema. The mean duration of follow-up at UCSF was 35.3 months (SD 25.7).By 12 months, 18 eyes (69.2%) had achieved resolution of ME. The median time to resolution was 3 months (IQR 3–6 months). Median best-corrected visual acuity (BCVA) at baseline was 0.54 logMAR (Snellen 20/69, IQR 20/40 to 20/200). Median BCVA at 12 months was 0.1 logMAR (Snellen 20/25, IQR 20/20 to 20/50) Corticosteroid injections were associated with a 4.0-fold higher rate of macular edema resolution (95% CI 1.3–12.2, P = 0.01).ConclusionsAlthough only 15% of the pediatric patients with uveitis in the study cohort had ME, it is clinically important to conduct OCTs to detect ME in this population. Treatment resulted in 69% of eyes achieving resolution of ME by 12 months, accompanied with improvement in visual acuity. Corticosteroid injections were significantly associated with resolution of macular edema.

Highlights

Treatment of children with uveitis presents unique challenges
Given the potentially severe impact of macular edema on vision in pediatric patients and the limited information available, this study aimed to assess clinical outcomes of macular edema in children with noninfectious uveitis and determine how treatment affects visual and macular thickness outcomes. This was a retrospective study of pediatric patients with noninfectious uveitis and macular edema conducted using the electronic health record system at the University of California San Francisco Medical Center, including the Francis I
The study cohort consisted of 26 eyes in 21 children, of which 13 were female and 8 were male

Summary

Introduction

Treatment of children with uveitis presents unique challenges. Pediatric patients account for less than 15% of patients in most uveitis clinics [7]. Thirty-four percent of children with uveitis present with at least one ocular complication at the time of diagnosis and 86.3% have ocular complications by 3 years after diagnosis [1]. These complications, such as cataracts, glaucoma, posterior synechiae and macular edema, often lead to irreversible structural damage and significant visual disability [1, 4]. Macular edema (ME) is the most frequent cause of irreversible visual impairment in patients with uveitis. A retrospective, observational study was performed to examine the visual and macular thickness outcomes of ME associated with chronic, noninfectious uveitis in pediatric patients

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