title: The Risk of Intraocular Pressure Elevation in Pediatric Noninfectious Uveitis.
abstract: OBJECTIVE
  To characterize the risk and risk factors for intraocular pressure (IOP) elevation in pediatric noninfectious uveitis.
  
  
  METHODS
  Multicenter retrospective cohort study.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: 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.
authors.forename: Srishti
authors.initials: S
authors.lastname: Kothari
authors.affiliation: The Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: C Stephen
authors.initials: CS
authors.lastname: Foster
authors.affiliation: 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.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Pistilli
authors.affiliation: Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Liesegang
authors.affiliation: Department of Ophthalmology, The Scheie Eye Institute, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Daniel
authors.affiliation: The Laboratory of Immunology, National Eye Institute, Bethesda, Maryland.
authors.forename: H Nida
authors.initials: HN
authors.lastname: Sen
authors.affiliation: Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Portland Veteran's Affairs Medical Center, Portland, Oregon.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Suhler
authors.affiliation: 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.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.affiliation: 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.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.affiliation: The Laboratory of Immunology, National Eye Institute, Bethesda, Maryland; The Tampa Bay Uveitis Center, Safety Harbor, Florida.
authors.forename: Grace A
authors.initials: GA
authors.lastname: Levy-Clarke
authors.affiliation: The Laboratory of Immunology, National Eye Institute, Bethesda, Maryland.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nussenblatt
authors.affiliation: 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.
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
authors.affiliation: Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Lawrence
authors.affiliation: 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.
authors.forename: John H
authors.initials: JH
authors.lastname: Kempen
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D009798:Ocular Hypertension / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014065:Tonometry, Ocular; D014605:Uveitis / Q000453:epidemiology / Q000503:physiopathology*; D014821:Vitrectomy