Original Articles
Visual loss associated with pediatric uveitis in english primary and referral centers

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Abstract

Purpose

Pediatric uveitis is rare and has been reported to cause increased rates of visual loss compared with adult patients. The reasons for this are unclear. Only one study has been population–based, so the effect of referral bias is not known. We examined the pattern of disease in primary and referral centers to establish the unique characteristics of uveitis in children.

Design

Case control study.

Methods

Retrospective, multicenter, observational study of uveitis starting before the age of 20 years. Two hundred forty-nine patients were recruited from three primary and two referral ophthalmic units. Age-related differences in types of uveitis and systemic disease between hospitals were characterized, as were associations with visual loss.

Results

The incidence of uveitis in district hospitals at less than 16 years of age was 4.9/100,000: the most frequent diagnosis was idiopathic uveitis (78%). In referral cohorts the most frequent diagnosis was juvenile idiopathic arthritis-associated uveitis (67%). Other systemic diseases were rare. The most frequent type of uveitis at 0 to 7 years of age was chronic anterior uveitis, posterior uveitis in 8- to 15-year-olds, and acute anterior uveitis in 16- to 19-year-olds. Visual loss (any eye < 6/12) occurred in 17% and was not associated with age, sex, or hospital cohort. It was most frequent in posterior uveitis (25%). Treatment variables were independent predictors of visual loss: systemic treatment 2.2 (1.1– 4.6), surgical intervention 8.2 (3.8–17.6).

Conclusions

Idiopathic uveitis was three times more common in district hospitals. Visual loss was similar to adult uveitis in this study. The increased frequency of severe chronic anterior uveitis in children aged 0 to 7 years and posterior uveitis in older children aged 8 to 15 years accounts for the rate of visual loss seen in previous studies.

Section snippets

Methods

All incident cases of uveitis with onset at less than 20 years of age were recorded in three district hospitals: the Prince Charles Eye Unit, Windsor, 1993 to 1994; Oxford Eye Hospital, 1995; and Ipswich Hospital, 1996 to 2001. The total incident population was 2.81 million younger, and the population aged younger than 16 was 557,012. Consecutive prevalent cases of uveitis with onset at age younger than 20 years of age at these hospitals were recruited in the same period.

Prevalent cases of

Results

The clinical and demographic characteristics of the complete cohort are shown in Table 1. On multivariate analysis, patients from referral hospitals were older, mean 12.6 years vs 6.1 years (Odds ratio [OR] 0.85, 0.78–0.93, P = .001); more likely to take systemic immunosuppression (OR, 16.1, 2.1–126.0, P = .008); more likely to have chronic anterior uveitis (OR, 4.93, 2.15–11.35, P = .001) and less likely to have acute anterior uveitis (OR, 0.08, 0.02–0.32, P = .001) compared with patients

Discussion

Pediatric uveitis is reported to be less common but more severe than that found in adults.1, 3, 5 Reported variations in the types of uveitis may be due not only to geographic differences but also to referral patterns and definitions of the pediatric age range. In this article we have investigated the differences in uveitis between hospital populations and age groups.

We have confirmed the low incidence of uveitis compared with adult populations. The earliest survey of uveitis7 found an annual

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