Vitreous hemorrhage in patients with uveitis: a comparative study between adults and children.

Abstract

Purpose: To compare clinical findings and visual outcomes of vitreous hemorrhage (VH) associated with uveitis in adults versus children.

Methods: A retrospective comparative study.

Results: There were 36 adults (44 eyes) and 10 children (12 eyes). Median age was 35 years in the adult group and 9.5 years in the pediatric group. VH was the presenting manifestation of the underlying uveitis in 45.7% of patients. VH in the adult group was more frequently associated with vascular sheathing, retinal hemorrhages, and extensive peripheral retinal ischemia on fluorescein angiography (FA), whereas VH in the pediatric group was associated with a significantly lower presenting visual acuity, and more frequently with vitritis and non-occlusive retinal vasculitis with fern-like retinal capillaritis. The most common source of bleeding was ischemia-driven retinal or optic disc neovascularization in the adult group (81.8%, p ≤ 0.001) and inflammation-driven optic disc neovascularization in the pediatric group (66.6%, p ≤ 0.001). A retinal vasoproliferative tumor was the cause of VH in one child (1.8%). Tuberculosis and Behçet's uveitis were the most common etiologies of uveitis in the adult group. Idiopathic intermediate uveitis/pars planitis was the leading cause of VH in the pediatric group. The mean final visual acuity was significantly higher in the pediatric group (20/25) than in the adult group (20/50) (p = 0.045).

Conclusions: VH associated with uveitis has a distinctive clinical and etiological profile between adults and children. The main source of bleeding was ischemia-driven neovascularization in adults and inflammation-driven neovascularization in children.