Incidence and Predictors of Ocular Complications in Pediatric-Onset Uveitis: Data from the AIDA Network Uveitis Registry

Introduction: This study aims to describe complications of pediatric-onset uveitis and their predictors among baseline and treatment-related factors. Methods: This registry-based observational study included patients with noninfectious uveitis with disease onset < 18 years. Results: A total of 309 patients were enrolled (535 eyes). Uveitis was anterior in 290 eyes (54.2%), panuveitis in 121 (22.6%), intermediate in 88 (16.4%), and posterior in 24 (4.5%). Over a median follow-up of 49.0 months (interquartile range [IQR] 101.0), 137 children (44.3%) developed ≥ 1 complication (14.4 per 100 patient-years). Idiopathic uveitis (p < 0.001), longer topical glucocorticoid (GC) monotherapy (p < 0.001) and longer delay of immunosuppressive therapy (IST) (p = 0.03) were associated with a higher frequency of complications. In multivariate analysis, anterior uveitis was protective against complications (odds ratio [OR] 0.10, 95% confidence interval [CI] − 4.1 to − 1.6, p < 0.001), whereas a chronic course of uveitis significantly increased the risk (OR 6.13, 95% CI 1.0–2.6, p < 0.001). Older age at onset was protective against cataract (OR 0.91, 95% CI − 0.2 to − 0.02, p = 0.020) and band keratopathy (OR 0.8, 95% CI − 0.4 to − 0.1, p = 0.003). Final best-corrected visual acuity (BCVA) (Snellen decimals) was inversely correlated with the duration of topical GC monotherapy (ρ = − 0.23; p = 0.001). In multivariate analysis, panuveitis was linked to a 0.142 decimal reduction (95% CI − 0.219 to − 0.066, p < 0.001), and cataract to a 0.295 reduction (95% CI − 0.372 to − 0.217, p < 0.001) in the final BCVA. Conclusions: Children with chronic, idiopathic, early-onset, and non-anterior uveitis are at greatest risk for complications. Structured screening for these children, along with early initiation of systemic IST, is essential to prevent visual impairment.