Nguyen Anh Hong, Mekonnen Bethlehem, Kim Eric, Acharya Nisha R
Department of Ophthalmology, University of California, 490 Illinois St, 2nd floor, San Francisco, CA, 94158, USA.
Francis I. Proctor Foundation, University of California, San Francisco, USA.
J Ophthalmic Inflamm Infect. 2021 Mar 15;11(1):8. doi: 10.1186/s12348-021-00236-4.
Macular edema (ME) is the most frequent cause of irreversible visual impairment in patients with uveitis. To date, little data exists about the clinical course of ME in pediatric patients. A retrospective, observational study was performed to examine the visual and macular thickness outcomes of ME associated with chronic, noninfectious uveitis in pediatric patients.
Pediatric patients with noninfectious uveitis complicated by ME seen in the University of California San Francisco Health System from 2012 to 2018 were identified using ICD-9 and ICD-10 codes. Data were collected from medical records including demographics, diagnoses, ocular history, OCT imaging findings, complications, and treatments at first encounter and at 3, 6, 9, and 12-month follow-up visits. Cox proportional hazards regression was used to investigate the association between different classes of treatment (steroid drops, steroid injections, oral steroids and other immunosuppressive therapies) and resolution of macular edema.
The cohort comprised of 21 children (26 eyes) with a mean age of 10.5 years (SD 3.3). Undifferentiated uveitis was the most common diagnosis, affecting 19 eyes (73.1%). The majority of observed macular edema was unilateral (16 patients, 76.2%) and 5 patients had bilateral macular edema. The mean duration of follow-up at UCSF was 35.3 months (SD 25.7). By 12 months, 18 eyes (69.2%) had achieved resolution of ME. The median time to resolution was 3 months (IQR 3-6 months). Median best-corrected visual acuity (BCVA) at baseline was 0.54 logMAR (Snellen 20/69, IQR 20/40 to 20/200). Median BCVA at 12 months was 0.1 logMAR (Snellen 20/25, IQR 20/20 to 20/50) Corticosteroid injections were associated with a 4.0-fold higher rate of macular edema resolution (95% CI 1.3-12.2, P = 0.01).
Although only 15% of the pediatric patients with uveitis in the study cohort had ME, it is clinically important to conduct OCTs to detect ME in this population. Treatment resulted in 69% of eyes achieving resolution of ME by 12 months, accompanied with improvement in visual acuity. Corticosteroid injections were significantly associated with resolution of macular edema.
黄斑水肿（ME）是葡萄膜炎患者不可逆视力损害的最常见原因。迄今为止，关于小儿患者ME临床病程的数据很少。进行了一项回顾性观察研究，以检查小儿患者中与慢性非感染性葡萄膜炎相关的ME的视力和黄斑厚度结果。
使用ICD-9和ICD-10编码识别2012年至2018年在加利福尼亚大学旧金山分校医疗系统中见到的并发ME的非感染性葡萄膜炎小儿患者。从病历中收集数据，包括人口统计学、诊断、眼部病史、OCT成像结果、并发症以及首次就诊和3、6、9和12个月随访时的治疗情况。使用Cox比例风险回归研究不同类别治疗（类固醇滴眼液、类固醇注射、口服类固醇和其他免疫抑制疗法）与黄斑水肿消退之间的关联。
该队列包括21名儿童（26只眼），平均年龄10.5岁（标准差3.3）。未分化葡萄膜炎是最常见的诊断，累及19只眼（73.1%）。观察到的大多数黄斑水肿为单侧（16例患者，76.2%），5例患者有双侧黄斑水肿。在加州大学旧金山分校的平均随访时间为35.3个月（标准差25.7）。到12个月时，18只眼（69.2%）的ME已消退。消退的中位时间为3个月（四分位间距3 - 6个月）。基线时最佳矫正视力（BCVA）的中位数为0.54 logMAR（Snellen 20/69，四分位间距20/40至20/200）。12个月时BCVA的中位数为0.1 logMAR（Snellen 20/25，四分位间距20/20至20/50）。皮质类固醇注射与黄斑水肿消退率高4.0倍相关（95%可信区间1.3 - 12.2，P = 0.01）。
尽管在研究队列中只有15%的葡萄膜炎小儿患者有ME，但对该人群进行OCT检查以检测ME在临床上很重要。治疗使69%的眼睛在12个月时ME消退，同时视力有所改善。皮质类固醇注射与黄斑水肿的消退显著相关。
