Visual and Clinical Outcome of Macular Edema Complicating Pediatric Noninfectious Uveitis

Published:February 14, 2019DOI:


      To investigate the clinical course and visual outcome of macular edema (ME) in pediatric patients with chronic noninfectious uveitis.


      Retrospective case series.


      The databases of the uveitis clinics of 4 tertiary medical centers in Israel and the UK were searched for all children treated for uveitic ME in the years 2005–2015. Data were collected from the medical records as follows: demographics, diagnosis, visual acuity, clinical and imaging findings, and treatment given specifically for ME. Findings at baseline and at 3, 6, 12, and 24 months were evaluated.


      The cohort included 25 children (33 eyes) of mean age 8.5 ± 3.4 years. The most common diagnosis was intermediate uveitis, in 14 children (7 idiopathic, 7 pars planitis). Uveitis was active at ME diagnosis in 28 eyes (84.8%). Median duration of follow-up was 48 months. Median time to resolution of ME was 6 months, with complete resolution in 25 eyes (75.8%) by 24 months. Baseline visual acuity was ≥20/40 in 8 eyes (24.2%), increased to 57.6% at 3 months (P < .0001), and remained stable thereafter. Treatment regimens included corticosteroids (systemically and/or locally), immunosuppression, and biologic therapies. No correlation was found between outcome and either structural characteristics of ME or specific treatment strategy.


      The prognosis of pediatric uveitic ME is favorable despite its chronic course. Larger randomized controlled trials are needed to define differences among treatment regimens.
      To read this article in full you will need to make a payment


      Subscribe to American Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Smith J.A.
        • Mackensen F.
        • Sen H.N.
        • et al.
        Epidemiology and course of disease in childhood uveitis.
        Ophthalmology. 2009; 116: 1544-1551, 1551.e1
        • Slabaugh M.A.
        • Herlihy E.
        • Ongchin S.
        • van Gelder R.N.
        Efficacy and potential complications of difluprednate use for pediatric uveitis.
        Am J Ophthalmol. 2012; 153: 932-938
        • Rothova A.
        • Suttorp-van Schulten M.S.
        • Frits Treffers W.
        • Kijlstra A.
        Causes and frequency of blindness in patients with intraocular inflammatory disease.
        Br J Ophthalmol. 1996; 80: 332-336
        • Lardenoye C.W.
        • van Kooij B.
        • Rothova A.
        Impact of macular edema on visual acuity in uveitis.
        Ophthalmology. 2006; 113: 1446-1449
        • de Boer J.N.
        • Wulffraat N.
        • Rothova A.
        Visual loss in uveitis of childhood.
        Br J Ophthalmol. 2003; 87: 879-884
        • Jain R.
        • Ferrante P.
        • Reddy G.T.
        • Lightman S.
        Clinical features and visual outcome of intermediate uveitis in children.
        Clin Exp Ophthalmol. 2005; 33: 22-25
        • Lei S.
        • Lam W.C.
        Efficacy and safety of dexamethasone intravitreal implant for refractory macular edema in children.
        Can J Ophthalmol. 2015; 50: 236-241
        • Androudi S.
        • Letko E.
        • Meniconi M.
        • Papadaki T.
        • Ahmed M.
        • Foster C.S.
        Safety and efficacy of intravitreal triamcinolone acetonide for uveitic macular edema.
        Ocul Immunol Inflamm. 2005; 13: 205-212
        • Tomkins-Netzer O.
        • Lightman S.
        • Drye L.
        • et al.
        Multicenter Uveitis Steroid Treatment Trial Research Group. Outcome of treatment of uveitic macular edema: The Multicenter Uveitis Steroid Treatment Trial 2-year results.
        Ophthalmology. 2015; 122: 2351-2359
        • Ramanan A.V.
        • Dick A.D.
        • Jones A.P.
        • SYCAMORE Study Group
        Adalimumab plus methotrexate for uveitis in juvenile idiopathic arthritis.
        N Engl J Med. 2017; 376: 1637-1646
        • Sood A.B.
        • Angeles-Han S.T.
        An update on treatment of pediatric chronic non-infectious uveitis.
        Curr Treatm Opt Rheumatol. 2017; 3: 1-16
        • Jaffe G.
        • Thorne J.
        • Scales D.
        • et al.
        SAT0523 adalimumab in patients with active, non-infectious uveitis requiring high-dose corticosteroids: the Visual-1 Trial.
        Ann Rheum Dis. 2015; 74: 849-850
        • Nguyen Q.D.
        • Merrill P.T.
        • Jaffe G.J.
        • et al.
        Adalimumab for prevention of uveitic flare in patients with inactive non-infectious uveitis controlled by corticosteroids (VISUAL II): a multicentre, double-masked, randomised, placebo-controlled phase 3 trial.
        Lancet. 2016; 388: 1183-1192
        • Sardar E.
        • Dusser P.
        • Rousseau A.
        • Bodaghi B.
        • Labetoulle M.
        • Koné-Paut I.
        Retrospective study evaluating treatment decisions and outcomes of childhood uveitis not associated with juvenile idiopathic arthritis.
        J Pediatr. 2017; 186: 131-137.e1
        • Sharma S.M.
        • Dick A.D.
        • Ramanan A.V.
        Non-infectious pediatric uveitis: an update on immunomodulatory management.
        Paediatr Drugs. 2009; 11: 229-241
        • Rothova A.
        Inflammatory cystoid macular edema.
        Curr Opin Ophthalmol. 2007; 18: 487-492
        • Taylor S.R.
        • Habot-Wilner Z.
        • Pacheco P.
        • Lightman S.L.
        Intraocular methotrexate in the treatment of uveitis and uveitic cystoid macular edema.
        Ophthalmology. 2009; 116: 797-801
        • Schaap-Fogler M.
        • Amer R.
        • Friling R.
        • Priel E.
        • Kramer M.
        Anti-TNF-α agents for refractory cystoid macular edema associated with noninfectious uveitis.
        Graefes Arch Clin Exp Ophthalmol. 2014; 252: 633-640
        • Mackensen F.
        • Jakob E.
        • Springer C.
        • et al.
        Interferon versus methotrexate in intermediate uveitis with macular edema: results of a randomized controlled clinical trial.
        Am J Ophthalmol. 2013; 156: 478-486.e1
        • Lasave A.F.
        • Schlaen A.
        • Zeballos D.G.
        • et al.
        Twenty-four months follow-up of intravitreal bevacizumab injection versus intravitreal triamcinolone acetonide injection for the management of persistent non-infectious uveitic cystoid macular edema.
        Ocul Immunol Inflamm. 2017; : 1-9
        • Lam D.S.
        • Fan D.S.
        • Ng J.S.
        • Yu C.B.
        • Wong C.Y.
        • Cheung A.Y.
        Ocular hypertensive and anti-inflammatory responses to different dosages of topical dexamethasone in children: a randomized trial.
        Clin Exp Ophthalmol. 2005; 33: 252-258
        • Sallam A.
        • Corner R.M.
        • Chang J.H.
        • et al.
        Short-term safety and efficacy of intravitreal triamcinolone acetonide for uveitic macular edema in children.
        Arch Ophthalmol. 2008; 126: 200-205
        • Sella R.
        • Oray M.
        • Friling R.
        • Umar L.
        • Tugal-Tutkun I.
        • Kramer M.
        Dexamethasone intravitreal implant (Ozurdex®) for pediatric uveitis.
        Graefes Arch Clin Exp Ophthalmol. 2015; 253: 1777-1782
        • Habot-Wilner Z.
        • Sallam A.
        • Roufas A.
        • et al.
        Periocular corticosteroid injection in the management of uveitis in children.
        Acta Ophthalmol. 2010; 88: e299-e304
        • Al-Dhibi H.
        • Khan A.O.
        Bilateral response following unilateral intravitreal bevacizumab injection in a child with uveitic cystoid macular edema.
        J AAPOS. 2009; 13: 400-402
        • Trittibach P.
        • Koerner F.
        • Sarra G.M.
        • Garweg J.G.
        Vitrectomy for juvenile uveitis: prognostic factors for the long-term functional outcome.
        Eye (Lond). 2006; 20: 184-190
        • Sohn E.H.
        • Chaon B.C.
        • Jabs D.A.
        • Folk J.C.
        Peripheral cryoablation for treatment of active pars planitis: long-term outcomes of a retrospective study.
        Am J Ophthalmol. 2016; 162: 35-42.e2
        • de Boer J.
        • Steijaert A.
        • van den Bor R.
        • Stellato R.
        • Ossewaarde-van Norel J.
        Development of macular edema and impact on visual acuity in uveitis associated with juvenile idiopathic arthritis.
        Ocul Immunol Inflamm. 2015; 23: 67-73
        • Taylor S.R.
        • Lightman S.L.
        • Sugar E.A.
        • et al.
        The impact of macular edema on visual function in intermediate, posterior, and panuveitis.
        Ocul Immunol Inflamm. 2012; 20: 171-181
        • Iannetti L.
        • Spinucci G.
        • Abbouda A.
        • De Geronimo D.
        • Tortorella P.
        • Accorinti M.
        Spectral-domain optical coherence tomography in uveitic macular edema: morphological features and prognostic factors.
        Ophthalmologica. 2012; 228: 13-18