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Inflammation, ocular complications tied to cataract development in paediatric uveitis

16 Mar 2017

Paediatric patients with uveitis commonly develop cataract, and the risk of cataract development increases with the extent of inflammation recurrences and ocular complications, according to a cohort study.

With the aim of determining risk factors for the development of vision-affecting cataract, researchers examined 247 eyes of 140 children with uveitis. Demographic, clinical and treatment information were obtained between the time of presentation and the first instance of cataract. Primary outcome measures included the prevalence of cataract and distribution by type of uveitis, the associated risk factors, incidence of new-onset cataract and time to cataract development.

Data indicated that the prevalence of cataract overall was 44.2 percent, the highest observed among patients with panuveitis (77.1 percent), chronic anterior uveitis (48.3 percent) and intermediate uveitis (48.0 percent). Newly diagnosed cataract occurred at a rate of 0.09/eye-year, with approximately 69 percent of patients developing uveitis-related cataract over time.

Factors strongly associated with cataract development included the number of uveitis flares per year (hazard ratio [HR], 3.06; 95 percent CI, 2.15 to 4.35; p<0.001), cystoid macular oedema (HR, 2.87; 1.41 to 5.82; p=0.004), posterior synechia at presentation (HR, 2.85; 1.53 to 5.30; p=0.001) and use of local corticosteroid injections (HR, 2.37; 1.18 to 4.75; p=0.02). Treatment with systemic and topical corticosteroids, on the other hand, did not contribute to an increased risk of developing cataract.

Of uveitis patients seen at tertiary referral centres, about 5 to 10 percent are children. Compared with adults, paediatric patients are said to have a higher degree of uveitis severity mostly due to the development of vision-threatening ocular complications. Additionally, the cause of uveitis differs significantly depending upon the population being examined. Juvenile idiopathic arthritis, for instance, is the most common cause in the US and northern European countries and is uncommon in Mediterranean and Middle Eastern countries.  [J Ophthalmic Vis Res 2011;6:259–69; Ophthalmology 2004;111:2299–306; Ocul Immunol Inflamm 2000;8:251–61]

Given the frequency of cataract development in paediatric uveitis patients observed in the present study, researchers stressed the importance of controlling inflammation, even using higher doses of systemic and topical corticosteroids, to prevent ocular complications such as cataract.

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