Young age as a risk factor for complicated course and visual outcome in intermediate uveitis in children

Objective To identify prognostic factors in intermediate uveitis (IU) in children. Methods Retrospective case series of 35 patients with onset of IU ≤16 years and a minimum follow-up of 1 year. Demographic and numerous clinical data were documented. Visual outcomes and development of complications were analysed in relation to age of onset and ocular signs at presentation. Results Forty-six per cent of patients had onset ≤7 years, and 54% >7 years. The younger-onset group had a shorter event-free survival for secondary glaucoma (p=0.04) and vitreous haemorrhage (p=0.01). The mean age of onset in children with cataract (5.9 vs 8.7 years), glaucoma (5.0 vs 8.4) and vitreous haemorrhage (5.6 vs 8.5) was lower than in children without these complications (all p=0.03). Frequencies of other complications did not differ between both groups. The younger-onset group had worse BCVAs at presentation (0.3 vs 0.6), at 1 year (0.4 vs 0.9) and at 3 years9 follow-up (0.6 vs 0.9; all p≤0.04), and they needed longer treatment (p=0.01). Children with young onset of IU reached remission less frequently (p=0.05). Development of cystoid macular oedema was independently associated with papillitis (adjusted HR=3.4; p=0.02) and snowbanking (adjusted HR=3.3; p=0.03) at presentation. Other complications at onset were not predictive for future complications. Conclusions Children with young onset of IU carry a higher risk of complications and worse visual outcome. The authors would recommend considering more intensive monitoring and earlier threshold for systemic treatment in those children with risk factors as early onset, papillitis and/or snowbanking at initial presentation.