The Detection of Occult Retinal Vasculitis on Fluorescein Angiography in Pediatric Uveitis Ashley Abraham, MD, 1,2 Ujwala S. Saboo, MD, 1,2,3 Bruna L. Ducca, MD, 1,2 Araceli T. Lawand, MD, 1,2 Cristiana Ronconi, MD, 1,2 Jennifer H. Cao, MD 1,2 Purpose: To evaluate the usefulness of fluorescein angiography (FA) to detect occult retinal vasculitis in children with otherwise apparently quiescent intermediate uveitis, posterior uveitis, and panuveitis based on clinical examination alone. Design: Retrospective chart review. Participants: Pediatric uveitis patients evaluated at the Children’s Medical Center in Dallas, Texas. Methods: Retrospective chart review of pediatric patients treated with immunosuppressive therapy in the uveitis clinic at the Children’s Medical Center, Dallas, Texas, between September 2015 and September 2016. Patients with noninfectious uveitis requiring immunosuppressive therapy, in which posterior segment involvement (intermediate uveitis, posterior uveitis, or panuveitis) was known or suspected, and whose disease apparently was quiescent on clinical examination were included. Main Outcome Measures: The incidence of occult retinal vasculitis detected on FA alone. Results: Fourteen pediatric patients met inclusion criteria. Six patients (43%) demonstrated intermediate uveitis, and 8 patients (57%) demonstrated panuveitis. Eleven patients (79%) were found to show additional evidence of occult retinal vasculitis on FA. Conclusions: Fluorescein angiography can be an important tool in evaluating pediatric uveitis patients with known or suspected posterior involvement for the presence of occult retinal vasculitis. Failure to control occult retinal vasculitis adequately may be a contributing factor to seemingly recalcitrant cases, inability to wean off immunomodulatory therapy, and long-term complications leading to poor prognosis. Ophthalmology Retina 2019;-:1e6 ª 2019 by the American Academy of Ophthalmology Noninfectious uveitis remains a serious cause of blindness in the United States. It is estimated that 30 000 people become legally blind as a result of uveitis annually. 1 Inability of children to verbalize symptoms, delayed presentation, and unique challenges of examining a child often complicate the identification, diagnosis, and management of pediatric uveitis. Furthermore, the potential absolute long-term dura- tion of disease in children compared with those with adult- onset uveitis increases lifetime potential for accumulation of uveitic complications. Thus, despite a lower overall incidence of uveitis in children as compared with adults, children tend to have a more severe course leading to permanent vision loss. Those specifically with posterior-involving uveitis, which accounts for approximately 40% of cases of pediatric uveitis, tend to have a significantly greater risk of vision loss throughout the disease course. 2 Fluorescein angiography (FA) is a valuable tool for assessing retinal vascular involvement in retinal disease. 3 Retinal vasculitis has been shown to be a risk factor for poor prognosis. 4 Although many studies have described the role of FA in the management of adult uveitis with posterior involvement, 3 clinical examination by means of slit-lamp microscopy and indirect ophthalmoscopy re- mains the standard for assessing uveitis status in children. Although FA often is used in the management of other pediatric retinal vascular disorders, including Coats’ dis- ease and retinopathy of prematurity, the role of FA is not routine in all practices caring for patients with uveitis, particularly pediatric uveitis. 5 Karel et al 6 first described the use of FA for pediatric uveitis in 1973. However, this method in children historically has been limited by logistical issues such as the need for sedation in those who are younger, less cooperative, or both; increased healthcare cost; and the lack of suitable bedside imaging systems. Recently, with the advent of newer wide-angle digital imaging systems, the ability to obtain high-quality fundus imaging in children has become increasingly accessible. Literature addressing the use of FA studies in pediatric uveitis is lacking. The question remains whether the benefits of obtaining FA in children outweigh the logis- tical concerns and whether FA provides substantial additional information beyond clinical examination alone. This study evaluates the usefulness of FA in children and 1 Ó 2019 by the American Academy of Ophthalmology Published by Elsevier Inc. https://doi.org/10.1016/j.oret.2019.09.007 ISSN 2468-6530/19