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Cataract commonly occurs in paediatric eyes with uveitis

12 May 2017

Children with uveitis commonly develop cataract, and the development of the eye disease is strongly associated with the extent of inflammation recurrences and ocular complications, according to a cohort study.

Researchers examined 247 eyes of 140 children with uveitis for the development of vision-affecting cataract. Collection of demographic, clinical and treatment data was done from the time of presentation to the first instance cataract was recorded or the final follow-up.

Primary outcomes of interest were the prevalence of cataract and distribution by type of uveitis, incidence of new onset cataract, time to cataract development and risk factors for the development of cataract.

Cataract prevalence was 44.2 percent in the cohort, being highest in the groups of children with panuveitis (77.1 percent), chronic anterior uveitis (48.3 percent) and intermediate uveitis (48.0 percent). Newly diagnosed cataract had an overall incidence of 0.09 per eye-year, with 69 patients estimated to develop uveitis-related cataract over time.

Significant risk factors for cataract development were 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). Systemic and topical corticosteroid treatment were not significantly related to cataract development.

The current data highlight the importance of controlling inflammation in paediatric eyes with uveitis, even using higher doses of systemic and topical corticosteroids, in preventing ocular complications, such as cataract, researchers said.

In children, cataract induces more visual disability compared with any other form of treatable blindness. If left untreated, the disease may result in a lifetime of blindness. There are more than 200,000 children who have lost their sight due to unoperated cataract, complications of cataract surgery or ocular anomalies associated with cataracts. Still, many more are affected by partial cataracts that may slowly progress over time, increasing visual difficulties as the children grow. [Gilbert C. Worldwide causes of blindness in children. In: Wilson ME, et al, eds. Pediatric Ophthalmology: Current Thought and a Practical Guide. Springer: Heidelberg 2009; Invest Ophthalmol Vis Sci 2004;45:1316–1320]

Paediatric cataract management can be tedious and difficult, requiring many visits over many years. Early detection is warranted to allow more timely treatment of the eye disease in the future, and vision screening programmes and improved education of primary health care workers and the public will help facilitate such change. [https://www.aao.org/pediatric-center-detail/pediatric-cataracts-overview]

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