Pediatric Uveitic Macular Edema in Non-Infectious Uveitis: Structural and Visual Outcomes and Predictors of Visual Prognosis

To characterize the clinical features, multimodal imaging findings, and long-term visual and structural outcomes of pediatric uveitic macular edema (UME), and to identify longitudinal predictors of visual prognosis. Retrospective observational cohort study. Thirty-one eyes of 20 pediatric patients with noninfectious uveitis complicated by UME treated at a tertiary referral center. Medical records of children diagnosed with UME were retrospectively reviewed. Baseline was defined as the first visit demonstrating intraretinal cysts on spectral-domain optical coherence tomography (OCT). Clinical, imaging, and treatment data were collected at baseline, visits closest to 3, 6, and 12 months, and last available follow-up. OCT parameters included central macular thickness (CMT), subfoveal choroidal thickness (SFCT), intraretinal fluid (IRF), subretinal fluid (SRF), intraretinal hyperreflective foci (IHRF), disorganization of retinal inner layers (DRIL), and ellipsoid zone/external limiting membrane (EZ/ELM) disruption. Longitudinal outcomes were analyzed using linear mixed-effects models accounting for inter-eye correlation. Best-corrected visual acuity (BCVA), OCT structural changes, inflammatory control, treatment patterns, and predictors of BCVA at 12 months. Median age at baseline was 13 years (IQR, 9-14) with a median follow-up of 3.2 years (IQR, 1.5-4.5). Median BCVA improved from 0.4 logMAR (20/50; IQR 0.18-0.88) at baseline to 0.18 logMAR (∼20/30; IQR, 0-0.51) at final follow-up (p=0.002). Median CMT significantly decreased from 422 μm (IQR, 350-532) at baseline to 292 μm (IQR, 264-328) at last follow-up (p<0.001). The proportion of eyes with IRF declined from 100% (31/31) at baseline to 19.2% (5/31) at final follow-up, and SRF resolved in all eyes from 6 months onward (p<0.001). Inflammatory activity also decreased significantly over time. Use of immunomodulatory therapy increased from 30% at baseline to 90% at final follow-up (p<0.001), whereas systemic corticosteroid use progressively declined. In multivariable analysis, worse BCVA (p<0.001) and EZ/ELM disruption (p=0.006) during early follow-up independently predicted worse BCVA at 12 months. Pediatric UME demonstrates substantial anatomical improvement and stabilization of visual function under contemporary immunomodulatory strategies. Early BCVA and photoreceptor layer integrity (EZ/ELM) were associated with visual outcomes and may help identify children at risk for poorer prognosis requiring earlier therapeutic escalation.