A recent study determined that longitudinal changes in corneal endothelial cell density (ECD) were not actually associated with uveitis in children; instead, the changes are linked with intraocular surgery for uveitis-related complications.

While the endothelial reserve remained robust among the children of the study, the researchers found it striking that a single intraocular procedure often results in a statistically significant ECD loss.

The study analyzed 99 children with anterior chamber inflammation and those at risk of developing uveitis due to juvenile idiopathic arthritis and compared them with 11 controls. The children at risk were separated into two groups, 72 without prior surgery and 27 who had prior ophthalmic surgery. The annual rates of ECD decline in the control group (0.2%/year) and the two subgroups of patients with uveitis (0.7%–0.8%/year) were not significantly different.

Once the researchers adjusted for the patient’s age, only intraocular procedures were associated with a significant annual rate of ECD loss. Even though the decrease in ECD observed was not clinically significant in the immediate short-term and did not cause corneal edema, the researchers believe this decline could result in endothelial dysfunction at an earlier stage than otherwise expected as the patients age.

The researchers note that their cohort had a shorter duration of uveitis activity at recruitment and had only low-grade activity during the course of the study. Nevertheless, the study’s findings suggest that anterior uveitis intrinsically does not accelerate the normal age-related ECD decline and support the researchers’ notion that prevention of uveitic complications—and thus the number of intraocular surgeries—could help avoid unnecessary ECD loss.

“The management of ocular surface transplant patients is very challenging even in adult patients," says researcher Edward J. Holland, MD, director of Cornea at the Cincinnati Eye Institute. "Children with ocular surface failure are even more complex and often told there is nothing available or managed with a keratoprosthesis, which is very risky in this age group. This study demonstrates that with careful follow-up and the collaboration of a pediatric kidney transplant team, ocular surface transplantation in children is safe and can achieve good outcomes.”

Fung SSM, El Hamouly A, Sami H, et al. Corneal endothelium in pediatric patients with uveitis: a prospective longitudinal study. Br J Ophthalmol. June 10, 2020. [Epub ahead of print].