The risk of intraocular pressure elevation in pediatric noninfectious uveitis

Systemic Immunosuppressive Therapy for Eye Diseases Research Group

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1987-2001
Number of pages15
JournalOphthalmology
Volume122
Issue number10
DOIs
StatePublished - Oct 1 2015

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Uveitis
Intraocular Pressure
Pediatrics
Adrenal Cortex Hormones
Temazepam
Vitrectomy
Incidence
Immunosuppressive Agents
Cataract
Visual Acuity
Medical Records

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Systemic Immunosuppressive Therapy for Eye Diseases Research Group (2015). The risk of intraocular pressure elevation in pediatric noninfectious uveitis. Ophthalmology, 122(10), 1987-2001. https://doi.org/10.1016/j.ophtha.2015.06.041

The risk of intraocular pressure elevation in pediatric noninfectious uveitis. / Systemic Immunosuppressive Therapy for Eye Diseases Research Group.

In: Ophthalmology, Vol. 122, No. 10, 01.10.2015, p. 1987-2001.

Research output: Contribution to journalArticle

Systemic Immunosuppressive Therapy for Eye Diseases Research Group 2015, 'The risk of intraocular pressure elevation in pediatric noninfectious uveitis', Ophthalmology, vol. 122, no. 10, pp. 1987-2001. https://doi.org/10.1016/j.ophtha.2015.06.041
Systemic Immunosuppressive Therapy for Eye Diseases Research Group. The risk of intraocular pressure elevation in pediatric noninfectious uveitis. Ophthalmology. 2015 Oct 1;122(10):1987-2001. https://doi.org/10.1016/j.ophtha.2015.06.041
Systemic Immunosuppressive Therapy for Eye Diseases Research Group. / The risk of intraocular pressure elevation in pediatric noninfectious uveitis. In: Ophthalmology. 2015 ; Vol. 122, No. 10. pp. 1987-2001.
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title = "The risk of intraocular pressure elevation in pediatric noninfectious uveitis",
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.",
author = "{Systemic Immunosuppressive Therapy for Eye Diseases Research Group} and Srishti Kothari and Foster, {C. Stephen} and Maxwell Pistilli and Liesegang, {Teresa L.} and Ebenezer Daniel and Sen, {H. Nida} and Suhler, {Eric B.} and Jennifer Thorne and Jabs, {Douglas A.} and Levy-Clarke, {Grace A.} and Nussenblatt, {Robert B.} and Rosenbaum, {James T.} and Lawrence, {Scott D.} and Kempen, {John H.}",
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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

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.

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.

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