Ocular Manifestations of Pediatric Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Background and aims: Ocular extraintestinal manifestations (O-EIMs) are known complications of Crohn's disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBD-U). However, data on their prevalence in children are scarce and there are no clear recommendations on which follow-up should be offered. We aimed to review available data on O-EIMs in children. Methods: In January 2018, we performed a systematic review of published English literature using PubMed and EMBASE databases using disease-specific queries. Results: Fifteen studies (7467 patients) reported data on O-EIMs prevalence in children. Overall prevalence of O-EIMs was 0.62% - 1.82%. Uveitis was the most common O-EIM. Meta-analysis showed that children with CD are at increased risk of O-EIMs as compared with children with UC and IBD-U (OR 2.70, 95% CI 1.51-4.83). Five studies (357 patients) reported data on ophthalmologic screening in asymptomatic children: mild asymptomatic uveitis was identified in a variable proportion of patients (1.06%-23.1%), more frequently in male patients with CD and colonic involvement. No evidence of ocular complications from untreated uveitis was detected. Twenty-three case reports (24 patients) were identified. Conclusions: Data on O-EIMs in children are scarce. Prevalence of O-EIMs is lower than in adults but may be underestimated because of the possibility of asymptomatic uveitis; however, the long-term significance of this condition is unknown. Children with CD may be at increased risk of O-EIMs. No recommendations on routine ophthalmological examination can be made but a low threshold for ophthalmologic referral should be maintained. Larger studies in pediatric IBD populations are needed.