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Corneal endothelium in paediatric patients with uveitis: a prospective longitudinal study
  1. Simon Sheung Man Fung1,2,3,
  2. Ali El Hamouly3,4,
  3. Hamza Sami3,4,
  4. Dishay Jiandani3,
  5. Sara Williams3,
  6. Nasrin Tehrani2,3,
  7. Kamiar Mireskandari2,3,
  8. Asim Ali2,3
  1. 1Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA
  2. 2Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
  4. 4Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Simon Sheung Man Fung, Jules Stein Eye Institute, Los Angeles, CA 90095, USA; simonfung{at}mednet.ucla.edu

Abstract

Purpose To study the longitudinal effect of anterior chamber inflammation on the corneal endothelium in children.

Methods In this prospective longitudinal observational study, children (aged <18 years) with anterior chamber inflammation and those at risk of developing uveitis due to juvenile idiopathic arthritis (JIA) were included. Changes in central endothelial cell density (ECD) and morphological variables were determined by non-contact specular microscopy, and their correlations with uveitis activity and surgical interventions were analysed.

Results Ninety-nine eyes of 99 children (mean age (±SD): 10.0±4.1 years) with a history of anterior chamber inflammation were recruited. Mean follow-up was 12.3±3.5 months. Eleven children, who were under surveillance but had not developed JIA-associated uveitis were included as controls. While there were no significant differences in mean ECD between controls and subjects without prior surgery (group 1) at all time points, those who had prior ophthalmic surgery (group 2) displayed significantly lower ECD than the controls at recruitment (p=0.002) and at follow-up (p=0.004). However, longitudinal ECD assessments did not show significant changes in either group (group 1, p=0.07, group 2, p=0.54). On regression analysis, once the patient’s age was adjusted for, only the occurrence of intraocular procedures during the study (r=0.43, adjusted p=0.03) was associated with a significant annual rate of ECD loss.

Conclusion During the study period, longitudinal ECD changes among children with uveitis were associated with intraocular surgery for uveitis-related complications but not uveitis activity. By reducing the need for surgical intervention, the corneal endothelium in these children may be preserved.

  • cornea
  • inflammation
  • anterior chamber
  • imaging
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Footnotes

  • Twitter @DrSimonFung

  • Contributors SSMF contributed to research design, data acquisition, data analysis and manuscript preparation of the study. AEH, HS, DJ and SW contributed to research design and data acquisition of the study. NT, KM and AA contributed to research design, data analysis and manuscript preparation of the study. AA is the guarantor of the study.

  • Funding SSMF received funding from Moorfields Eye Charity (grant no: ST 15 07 N) and HCA International Foundation (grant no: 1107145).

  • Competing interests AA is a consultant for Santen Canada in 2018–2019. KM was a consultant for AbbVie in 2016. He is also a consultant for Santen Canada in 2018. NT was a consultant for AbbVie in 2016.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Research Ethics Board of the Hospital for Sick Children, Toronto, Ontario, Canada and adheres to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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