Original article
Long-term Follow-up of Intermediate Uveitis in Children

https://doi.org/10.1016/j.ajo.2005.09.035Get rights and content

Purpose

To analyze the clinical manifestations, remissions, and visual prognosis of intermediate uveitis in children, and to identify the risk factors for poor visual outcome.

Methods

Institutional study of 32 consecutive patients examined at a tertiary referral center with intermediate uveitis and the onset of ocular disease before the age of 16 years. Numerous variables were assessed, including age and gender distribution, laboratory data, the presence of systemic diseases, onset and course of ocular inflammation, clinical features and complications, therapeutic strategies and their outcomes, remission and final visual acuity, and characteristics associated with poor visual outcome.

Results

Bilateral involvement was observed in 94% of the patients. Remission was observed in seven out of 15 patients (47%) with completed follow-up of five years. For our 32 subjects, we found a mean time to remission of 6.4 years (SE 0.7, CI 5.1 to 7.7). Visual outcome was favorable as only three patients developed unilateral acuity of less than 0.1 after five-year follow-up, and no additional blind eyes manifested. No associated systemic diseases were established. Optic disk edema was the most frequent complication observed (71%). Cystoid macular edema (CME) was observed in 44% of the patients and was the most common cause of visual loss.

Conclusions

Intermediate uveitis of childhood might exhibit a self-limiting course after several years. Visual loss was limited despite the high rate of severe ocular complications.

Section snippets

Methods

The study included 32 consecutive patients with onset of IU at less than 16 years of age from the tertiary referral center between 1994 and 2003, who presented with IU according to the diagnostic criteria of the International Uveitis Study Group.12 Briefly, the ocular inflammation had to involve the anterior vitreous, the peripheral retina, and the ciliary body, with or without anterior segment and without chorioretinal inflammatory signs, except snow banking.12 Anterior segment inflammation in

Results

Our series included 14 girls (44%) and 18 boys (56%). The uveitis was unilateral in two patients (6%) and bilateral in 30 patients (94%), resulting in 62 affected eyes. The mean follow-up was 4.5 years (range from six months to twelve years; 15 patients were followed for at least five years and 11 patients for at least eight years).

The mean age at onset of uveitis was 8.5 years (range three to fifteen years). The uveitis had a chronic course in all cases (disease duration of minimal 2.5 years).

Discussion

This study demonstrates that spontaneous remission of IU might occur in pediatric patients with IU. In our population, we observed remission in seven out 15 patients after five-year follow-up. Patients and parents are frequently informed that ocular inflammation might resolve during adolescence, but no exact data were available concerning remission rates in children. Since our follow-up was restricted to only a portion of our patients and our patient population was relatively small, the exact

Joke de Boer, MD, PhD, is a senior ophthalmologist at the Uveitis Clinic of the FC Donders Institute of Ophthalmology at the University Hospital Utrech, The Netherlands. She did her PhD research at The Netherlands Ophthalmic Research Institute on Infectious Uveitis. Dr de Boer specializes in Pediatric Uveitis and improved diagnostic tests for Infectious Uveitis using intraocular fluids of patients.

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    Joke de Boer, MD, PhD, is a senior ophthalmologist at the Uveitis Clinic of the FC Donders Institute of Ophthalmology at the University Hospital Utrech, The Netherlands. She did her PhD research at The Netherlands Ophthalmic Research Institute on Infectious Uveitis. Dr de Boer specializes in Pediatric Uveitis and improved diagnostic tests for Infectious Uveitis using intraocular fluids of patients.

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