The Risk of Intraocular Pressure Elevation in Pediatric Noninfectious Uveitis

Srishti Kothari; C Stephen Foster; Maxwell Pistilli; Teresa L Liesegang; Ebenezer Daniel; H Nida Sen; Eric B Suhler; Jennifer E Thorne; Douglas A Jabs; Grace A Levy-Clarke; Robert B Nussenblatt; James T Rosenbaum; Scott D Lawrence; John H Kempen; Systemic Immunosuppressive Therapy for Eye Diseases Research Group

doi:10.1016/j.ophtha.2015.06.041

The Risk of Intraocular Pressure Elevation in Pediatric Noninfectious Uveitis

Ophthalmology. 2015 Oct;122(10):1987-2001. doi: 10.1016/j.ophtha.2015.06.041. Epub 2015 Jul 30.

Authors

Collaborators

Systemic Immunosuppressive Therapy for Eye Diseases Research Group:
John H Kempen, Marshall M Joffe, Kurt A Dreger, Tonetta D Fitzgerald, Craig W Newcomb, Maxwell Pistilli, Srishti Kothari, Naira Khacharyan, Pichaporn Artornsombudh, Asaf Hanish, Abhishek Payal, Sapna S Gangaputra, Jennifer E Thorne, Hosne Begum, Kurt A Dreger, Ebenezer Daniel, James P Dunn, Sapna S Gangaputra, Douglas A Jabs, Abhishek Payal, Kathy J Helzlsouer, Douglas A Jabs, C Stephen Foster, Srishti Kothari, Naira Khacharyan, Pichaporn Artornsombudh, R Oktay Kaçmaz, Abhishek Payal, Siddharth S Pujari, H Nida Sen, Robert B Nussenblatt, Grace A Levy-Clarke, Sapna S Gangaputra, Eric B Suhler, James T Rosenbaum, Teresa Liesegang, Jeanine Buchanich, Terri L Washington

Affiliations

¹ The Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts; Department of Ophthalmology, The Scheie Eye Institute, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
² The Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
³ Department of Ophthalmology, The Scheie Eye Institute, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; The Center for Preventive Ophthalmology and Biostatistics, The Scheie Eye Institute, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
⁴ Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon.
⁵ Department of Ophthalmology, The Scheie Eye Institute, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
⁶ The Laboratory of Immunology, National Eye Institute, Bethesda, Maryland.
⁷ Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Portland Veteran's Affairs Medical Center, Portland, Oregon.
⁸ Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁹ Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York.
¹⁰ The Laboratory of Immunology, National Eye Institute, Bethesda, Maryland; The Tampa Bay Uveitis Center, Safety Harbor, Florida.
¹¹ Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Department of Medicine, Oregon Health and Science University, Portland, Oregon; The Devers Eye Institute, Portland, Oregon.
¹² Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina.
¹³ Department of Ophthalmology, The Scheie Eye Institute, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; The Center for Preventive Ophthalmology and Biostatistics, The Scheie Eye Institute, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: john.kempen@uphs.upenn.edu.

Abstract

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.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adolescent
Child
Female
Follow-Up Studies
Humans
Incidence
Intraocular Pressure / physiology*
Male
Ocular Hypertension / epidemiology
Ocular Hypertension / physiopathology*
Prevalence
Retrospective Studies
Risk Assessment
Risk Factors
Tonometry, Ocular
Uveitis / epidemiology
Uveitis / physiopathology*
Vitrectomy

Abstract

Publication types

MeSH terms

Grants and funding