Chronic anterior uveitis in children: clinical characteristics and complications

Gary N Holland, Christopher S Denove, Fei Yu
American Journal of Ophthalmology 2009, 147 (4): 667-678.e5

PURPOSE: To describe clinical features of chronic anterior uveitis in children at presentation to a referral center (baseline); to identify relationships between demographic, medical, and ophthalmic factors at baseline; and to determine baseline factors that predict new complications and vision loss during follow-up.

DESIGN: Retrospective case series.

METHODS: Studied were involved eyes of all children (age < or =16 years at disease onset) with chronic anterior uveitis who were examined by 1 clinician from 1993 through 2006. Cross-sectional analyses compared baseline findings. Relationships between potential risk factors and incident adverse events (new complications, vision loss) were studied by Kaplan-Meier and Cox proportional hazards regression models.

RESULTS: There were 115 patients (200 eyes) who met inclusion criteria. Follow-up (n = 83 patients) ranged from 0.4 to 157.5 months (median, 23.5 months). There were numerous strong relationships between 8 defined complications at baseline in pairwise comparisons. Flare was the inflammatory sign most consistently associated with complications at baseline. Baseline factors that predicted new complications during follow-up included age < or =3 years, elevated cells, elevated flare, keratic precipitates, signs of intermediate uveitis, and papillitis (all P < .043); factors that predicted vision loss included male gender, increased flare, signs of intermediate uveitis, papillitis, and baseline complications (all P < .015). Not related to new complications were presence of juvenile idiopathic uveitis and immunomodulatory therapy.

CONCLUSION: Chronic anterior uveitis in children is associated with various vision-threatening complications that occur in combinations. Complications develop early in the disease course. Patients with more severe disease at presentation are at increased risk of additional adverse events.

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