Complications Most Common in Children With Early-Onset, Chronic Uveitis

Preserving the vision of children with uveitis could be critical to avoid impairment, as a new study finds that children with chronic, nonanterior uveitis that appears at an early onset have an increased risk of complications compared with other groups, according to a new study.¹

Noninfectious uveitis is a condition that involves any intraocular inflammatory disorder, and between 2% and 20% of all cases are among children.² If the inflammation is not controlled well enough, it can lead to ocular complications. This study aimed to identify these complications as well as determine which groups of those with noninfectious uveitis had a higher risk based on different treatment or baseline characteristics.¹

The AIDA Network was used to collect data on children with uveitis, with any patient who had been diagnosed with noninfectious uveitis before the age of 18 years included in the study. A case-control design was used in an analysis that assessed the frequency and type of ocular complications, presence or absence of the most common complications, and presence or absence of at least 1 ocular complication by the end of the follow-up. Incidence rates of complications over time were assessed through longitudinal analyses.

Slit-lamp examination or optical coherence tomography was used to diagnose uveitis. Early-onset uveitis was defined as a diagnosis before 8 years of age, and limited uveitis was defined as lasting for less than 3 months; those who had uveitis for longer had persistent uveitis, and those who had repeated episodes of uveitis had recurrent uveitis.

There were 309 patients with 535 eyes who were enrolled in the study. An ocular complication was found in 44.3% of the children and 40.4% of the eyes for a median (IQR) of 49.0 (1.0-677.0) months. The most common complications included cataracts (17.2%), macular edema (8.8%), posterior synechiae (15.0%), glaucoma (4.3%), and band keratopathy (5.0%).

A total of 12.5% of those with early-onset uveitis required ocular surgery compared with 7.2% in those with late-onset uveitis.

In those with anterior uveitis, which was associated with a protective effect against complications, those with persistent chronic uveitis had complications in 54.7% of cases, those with persistent recurrent uveitis in 27.1% of cases, and those with limited acute uveitis in 8.9% of cases. Persistent chronic uveitis was a risk factor for the development of other complications (OR, 12.3; 95% CI, 1.5-3.5).

Ocular complications had an overall incidence of 14.4 events per 100 person-years, with cataracts having the highest incidence at 3.1 events per 100 person-years. Those who were diagnosed from 2021 on had the highest incidence of complications at 68.7 events per 100 person-years; those who were diagnosed before 2011 had the lowest at 6.6 events per 100 person-years.

There were some limitations to this study. Potential recall bias was possible due to the retrospective nature of the study. Due to the researchers using data from a registry, there was a possibility of incomplete data or variability between the different medical centers. Complication rates could have been affected by differences in follow-up duration. Detection of complications could have been affected by different schedules surrounding imaging. The generalizability could be limited due to missing data.

The researchers concluded that children who had isolated uveitis, early-onset disease, and nonanterior anatomical subtypes had a higher risk of having a complication related to their eyes.

“These patients should therefore receive more frequent and structured screening, along with timely, effective, and steroid-sparing treatment strategies,” the authors concluded.

References

1. Gaggiano C, De-la-Torre A, Cardona-López J, et al. Incidence and predictors of ocular complications in pediatric-onset uveitis: data from the AIDA Network Uveitis Registry. Ophthalmol Ther. Published online September 23, 2025. doi:10.1007/s40123-025-01237-5

2. Uveitis. Cleveland Clinic. Updated March 25, 2024. Accessed September 23, 2025. https://my.clevelandclinic.org/health/diseases/14414-uveitis