What question did this study set out to answer?

This study aimed to characterize features and outcomes of pediatric uveitic macular edema while identifying predictors for visual prognosis.

May 7, 2026Open Access

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

Key Points

This study aimed to characterize features and outcomes of pediatric uveitic macular edema while identifying predictors for visual prognosis.
Retrospective observational cohort study
Analyzed 31 eyes from 20 pediatric patients with non-infectious uveitis
Data collected included clinical, imaging, and treatment records, focusing on OCT findings
Longitudinal analysis performed using linear mixed-effects models accounting for inter-eye correlation
Median best-corrected visual acuity improved from 0.4 logMAR to 0.18 logMAR at final follow-up (p=0.002)
Median central macular thickness decreased significantly from 422 μm to 292 μm (p<0.001)
Inflammatory activity significantly decreased over time, with the use of immunomodulatory therapy rising from 30% to 90%
Worse BCVA and ellipsoid zone disruption predicted worse visual outcomes at 12 months

Abstract

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.

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