The Risk of Intraocular Pressure Elevation in Pediatric Noninfectious Uveitis.

Abstract

PURPOSE:

To characterize the risk and risk factors for intraocular pressure (IOP) elevation in pediatric noninfectious uveitis.

DESIGN:

Multicenter retrospective cohort study.

PARTICIPANTS:

Nine hundred sixteen children (1593 eyes) younger than 18 years at presentation with noninfectious uveitis followed up between January 1978 and December 2007 at 5 academic uveitis centers in the United States.

METHODS:

Medical records review by trained, certified experts.

MAIN OUTCOME MEASURES:

Prevalence and incidence of IOP of 21 mmHg or more and 30 mmHg or more and incidence of a rise in IOP by 10 mmHg or more. To avoid underascertainment, outcomes were counted as present when IOP-lowering therapies were in use.

RESULTS:

Initially, 251 (15.8%) and 46 eyes (2.9%) had IOP ≥21 mmHg and ≥30 mmHg, respectively. Factors significantly associated with presenting IOP elevation included age of 6 to 12 years (versus other pediatric ages), prior cataract surgery, pars plana vitrectomy, duration of uveitis ≥6 months, contralateral IOP elevation, presenting visual acuity worse than 20/40, and topical corticosteroid use (in a dose-response relationship). The median follow-up was 1.25 years (interquartile range, 0.4-3.66). The estimated incidence of any observed IOP elevation to ≥21 mmHg, to ≥30 mmHg, and increase in IOP by ≥10 mmHg was 33.4%, 14.8%, and 24.4%, respectively, within 2 years. Factors associated with IOP elevation included pars plana vitrectomy, contralateral IOP elevation (adjusted hazard ratio [aHR], up to 9.54; P < 0.001), and the use of topical (aHR, up to 8.77 that followed a dose-response relationship; P < 0.001), periocular (aHR, up to 7.96; P < 0.001), and intraocular (aHR, up to 19.7; P < 0.001) corticosteroids.

CONCLUSIONS:

Intraocular pressure elevation affects a large minority of children with noninfectious uveitis. Statistically significant risk factors include IOP elevation or use of IOP-lowering treatment in the contralateral eye and local corticosteroid use that demonstrated a dose-and route of administration-dependent relationship. In contrast, use of immunosuppressive drug therapy did not increase such risk. Pediatric eyes with noninfectious uveitis should be followed up closely for IOP elevation, especially when strong risk factors such as the use of local corticosteroids and contralateral IOP elevation are present.

• Authors: Srishti Kothari, C Stephen Foster, Maxwell Pistilli, Teresa L Liesegang, Ebenezer Daniel, H Nida Sen, Eric B Suhler, Jennifer E Thorne, Douglas A Jabs, Grace A Levy-Clarke, Robert B Nussenblatt, James T Rosenbaum, Scott D Lawrence, John H Kempen, Systemic Immunosuppressive Therapy for Eye Diseases Research Group
• Journal: Ophthalmology (Ophthalmology) Vol. 122 Issue 10 Pg. 1987-2001 (Oct 2015) ISSN: 1549-4713 [Electronic] United States
• PMID: 26233626 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: Copyright © 2015 American Academy of Ophthalmology. All rights reserved.

Topics

• Adolescent
• Child
• Female
• Follow-Up Studies
• Humans
• Incidence
• Intraocular Pressure (physiology)
• Male
• Ocular Hypertension (epidemiology, physiopathology)
• Prevalence
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Tonometry, Ocular
• Uveitis (epidemiology, physiopathology)
• Vitrectomy