TY - JOUR
T1 - The risk of intraocular pressure elevation in pediatric noninfectious uveitis
AU - Systemic Immunosuppressive Therapy for Eye Diseases Research Group
AU - Kothari, Srishti
AU - Foster, C. Stephen
AU - Pistilli, Maxwell
AU - Liesegang, Teresa L.
AU - Daniel, Ebenezer
AU - Sen, H. Nida
AU - Suhler, Eric B.
AU - Thorne, Jennifer E.
AU - Jabs, Douglas A.
AU - Levy-Clarke, Grace A.
AU - Nussenblatt, Robert B.
AU - Rosenbaum, James T.
AU - Lawrence, Scott D.
AU - Kempen, John H.
N1 - Publisher Copyright:
© 2015 American Academy of Ophthalmology.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84943455430&partnerID=8YFLogxK
U2 - 10.1016/j.ophtha.2015.06.041
DO - 10.1016/j.ophtha.2015.06.041
M3 - Article
C2 - 26233626
AN - SCOPUS:84943455430
SN - 0161-6420
VL - 122
SP - 1987
EP - 2001
JO - Ophthalmology
JF - Ophthalmology
IS - 10
ER -