Clinical Course of Ocular Hypotony in Pediatric Uveitis

PURPOSE: To assess the clinical course of ocular hypotony in a pediatric uveitis cohort. METHODS: The electronic medical records of children who developed ocular hypotony following uveitis were reviewed retrospectively. RESULT: Forty-one eyes of 30 children were included. There were 17 (56.7%) males and the mean age at presentation was 10.8 ± 4.2 years (aged: 2-16 years). Anterior uveitis was diagnosed in 10 (24.4%) eyes, intermediate in five (12.2%) eyes, posterior in one (2.4%) eye and panuveitis in 25 (61%) eyes. Nine eyes (22%) received intensified topical and/or oral therapy alone, 15 eyes (36.7%) received periocular injections, and nine eyes (22%) received intravitreal steroids with continued systemic and topical treatment. Surgical intervention was performed in 20 eyes (48.8%) to manage hypotony. Among these 20 eyes, silicon oil insertion was done in 10 eyes while in the remaining 10 eyes, pars plana vitrectomy (PPV) with ciliary body membrane removal was done. Following treatment, 16 (39%) eyes showed improvement with restoration of IOP. The visual acuity at baseline and last visit were 2.08 ± 1.31 and 1.82 ± 1.43 log MAR units respectively. The median follow-up duration was 580 days (IQR:191-1610 days). Nine (22%) eyes went into phthisis. CONCLUSION: Ocular hypotony in pediatric uveitis is a serious complication. Despite aggressive medical and surgical management, a significant proportion of eyes showed limited recovery, with nearly one-fourth progressing to phthisis. Early diagnosis, tailored treatment, and close monitoring are essential to improve visual and anatomical outcomes in this vulnerable population.