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The Role of Vitreo-Retinal Surgery in Children With Uveitis

Children represent a unique population of patients with special challenges in diagnosis and treatment of uveitis with a significant ocular morbidity. Relatively few symptoms often lead to late presentation to the ophthalmologist, and frequently with already established pathology and significant decrease in visual acuity. Difficulties in eliciting history, performing a review of systems, examining and treating children also pose special challenges. Uveitis in children is generally thought to account for only 5% to 10% of patients with uveitis. The annual incidence of childhood uveitis is estimated to be 4.3 to 6.9/100,000 in North America and Europe versus 26.6 to 102/100,000 for adults. The prevalence of pediatric uveitis is about 30 cases in 100,000 versus 93 in 100,000 in adults. However, despite a lower incidence of uveitis in children, the rate of visual loss may be worse than that of adults because of the nature of their clinical presentation and high complication rates. Severe visual loss may be anticipated in 25% to 33% of childhood uveitis cases. Anterior uveitis is the most common type of uveitis in children where the major etiologic factor is juvenile idiopathic arthritis (JIA), accounting for about 30% to 40% of cases, and is by far the most common systemic disease association of childhood uveitis. Other autoimmune conditions associated include Behcet syndrome, Kawasaki disease, sarcoidosis, Sjögren syndrome, and juvenile spondyloarthropathy. Posterior uveitis