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Identifying risk of blindness

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Complications of uveitis can be predicted early in children with idiopathic arthritis—an important advance, as this is the commonest form of anterior uveitis in children. Edelsten et al in the UK have reported risk factors associated with complications and remission based on a retrospective case review of children with painless anterior uveitis diagnosed between 1982 and 1998. They analysed endpoints for complications—cataract surgery, glaucoma, and loss of vision to <6/24—and for remission— inactive uveitis requiring no treatment for six months or more—against baseline characteristics on initial presentation. Children who had received treatment from onset at the study institute and had complied were assigned together to the standard cohort. Those who had initially been treated elsewhere, were poor compliers, had uveitis with another disease or uveitis presenting first with juvenile idiopathic arthritis were included in the non-standard cohort.

Overall, about a fifth (21%, 34/163) of children developed complications. Severe disease at onset of uveitis was a significant risk factor in both cohorts, multivariate analysis showed. For remission, it was mild onset. In all, 6% of children had severe sight loss (4% in the standard cohort) and 11% (6%) sustained moderate or severe loss respectively.

Severe disease at first visit predicts poor outcome and calls for aggressive immediate treatment. However, Edelsten et al also advocate earlier diagnosis—ultimately universal screening—and better treatment for and characterisation of those children with mild symptoms at onset whose uveitis nevertheless progresses to complications—almost half the total developing complications in this study.

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