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Paediatric anterior uveitis management in the USA: a single-centre, 10-year retrospective chart review exploring the efficacy and safety of systemic immunomodulatory therapy

Eye volume 37, pages 1325–1330 (2023)Cite this article

Subjects

Abstract

Objective

To evaluate the efficacy of immunomodulatory therapy (IMT) in paediatric anterior uveitis.

Methods

Chart review of all patients ≤ 18 years treated for anterior uveitis using a stepladder approach during a 10-year period. The type and duration of IMT were noted. The data were analysed depending on chronicity, aetiology, and type of IMT using appropriate statistical tests. The outcome measures included ocular complications, the need for surgical intervention, and visual outcomes.

Results

One hundred and thirty-four patients (191 eyes) were analyzed. The median age at diagnosis was 7 years (interquartile range (IQR): 7.5 years). The median follow-up was 4 years (IQR: 6 years). The most common causes of anterior uveitis were Juvenile idiopathic arthritis (64 patients, 47.8%) and undifferentiated (33 patients, 24.6%). All patients were started on topical steroids and cycloplegics. 94 (70%) patients required IMT. 92 (68.6%) were started on Methotrexate as the first agent, of which 21 (22%) were switched to a different agent owing to side effects. Biologic agent was added in 55 (41%) patients. 21 (16%) required switch to a second biologic agent, 5 (3.7%) to third, and 1 (0.8%) to fourth biologic agent. At the last exam, 11 (8%) had persistent inflammation. 55 (41%) had ocular complications, and 113 (84%) had a best corrected visual acuity ≥ 20/40.

Conclusion

Early introduction of IMT and switch to different agents may be required to control anterior uveitis and reduce the complications in children. IMT is safe and effective in treating paediatric anterior uveitis.

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Fig. 1: Overview of treatment modalities.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Kump LI, Cervantes-Castañeda RA, Androudi SN, Foster CS. Analysis of pediatric uveitis cases at a tertiary referral center. Ophthalmology. 2005;112:1287–92.

    Article  PubMed  Google Scholar 

  2. Rosenberg KD, Feuer WJ, Davis JL. Ocular complications of pediatric uveitis. Ophthalmology. 2004;111:2299–306.

    Article  PubMed  Google Scholar 

  3. Thorne JE, Suhler E, Skup M, Tari S, Macaulay D, Chao J, et al. Prevalence of noninfectious uveitis in the united states: A claims-based analysis. JAMA Ophthalmol. 2016;134:1237–45.

    Article  PubMed  Google Scholar 

  4. Smith JA, Mackensen F, Sen HN, Leigh JF, Watkins AS, Pyatetsky D, et al. Epidemiology and course of disease in childhood uveitis. Ophthalmology. 2009;116:1544–51. 1551.e1541

    Article  PubMed  Google Scholar 

  5. de Boer J, Wulffraat N, Rothova A. Visual loss in uveitis of childhood. Br J Ophthalmol. 2003;87:879–84.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cunningham ET Jr. Uveitis in children. Ocul Immunol Inflamm. 2000;8:251–61.

    Article  PubMed  Google Scholar 

  7. Nagpal A, Leigh JF, Acharya NR. Epidemiology of uveitis in children. Int Ophthalmol Clin. 2008;48:1–7.

    Article  PubMed  Google Scholar 

  8. Kadayifçilar S, Eldem B, Tumer B. Uveitis in childhood. J Pediatr Ophthalmol Strabismus. 2003;40:335–40.

    Article  PubMed  Google Scholar 

  9. Tugal-Tutkun I. Pediatric uveitis. J Ophthalmic Vis Res. 2011;6:259–69.

    PubMed  PubMed Central  Google Scholar 

  10. Cann M, Ramanan AV, Crawford A, Dick AD, Clarke SLN, Rashed F, et al. Outcomes of non-infectious paediatric uveitis in the era of biologic therapy. Pediatr Rheumatol Online J. 2018;16:51.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wentworth BA, Freitas-Neto CA, Foster CS. Management of pediatric uveitis. F1000Prime Rep. 2014;6:41.

  12. Curragh DS, O’Neill M, McAvoy CE, Rooney M, McLoone E. Pediatric uveitis in a well-defined population: Improved outcomes with immunosuppressive therapy. Ocul Immunol Inflamm. 2018;26:978–85.

    Article  PubMed  Google Scholar 

  13. Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, et al. 2019 American College of Rheumatology/arthritis foundation guideline for the screening, monitoring, and treatment of juvenile idiopathic arthritis-associated uveitis. Arthritis Care Res. 2019;71:703–16.

    Article  Google Scholar 

  14. Miraldi Utz V, Bulas S, Lopper S, Fenchel M, Sa T, Mehta M, et al. Effectiveness of long-term infliximab use and impact of treatment adherence on disease control in refractory, non-infectious pediatric uveitis. Pediatr Rheumatol Online J. 2019;17:79.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol. 2005;140:509–16.

    Article  PubMed  Google Scholar 

  16. Ferrara M, Eggenschwiler L, Stephenson A, Montieth A, Nakhoul N, Araùjo-Miranda R, et al. The challenge of pediatric uveitis: Tertiary referral center experience in the united states. Ocul Immunol Inflamm. 2019;27:410–7.

    Article  PubMed  Google Scholar 

  17. Couto C, Frick MM, LaMattina K, Schlaen A, Khoury M, Lopez MM, et al. Chronic anterior uveitis in children. Ocul Immunol Inflamm. 2016;24:392–6.

    Article  PubMed  Google Scholar 

  18. Clarke LA, Guex-Crosier Y, Hofer M. Epidemiology of uveitis in children over a 10-year period. Clin Exp Rheumatol. 2013;31:633–7.

    PubMed  Google Scholar 

  19. Zulian F, Martini G, Falcini F, Gerloni V, Zannin ME, Pinello L, et al. Early predictors of severe course of uveitis in oligoarticular juvenile idiopathic arthritis. J Rheumatol. 2002;29:2446–53.

    PubMed  Google Scholar 

  20. Kotaniemi K, Kautiainen H, Karma A, Aho K. Occurrence of uveitis in recently diagnosed juvenile chronic arthritis: a prospective study. Ophthalmology. 2001;108:2071–5.

    Article  CAS  PubMed  Google Scholar 

  21. Gregory AC 2nd, Kempen JH, Daniel E, Kaçmaz RO, Foster CS, Jabs DA, et al. Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis: the systemic immunosuppressive therapy for eye diseases study. Ophthalmology. 2013;120:186–92.

    Article  PubMed  Google Scholar 

  22. Woreta F, Thorne JE, Jabs DA, Kedhar SR, Dunn JP. Risk factors for ocular complications and poor visual acuity at presentation among patients with uveitis associated with juvenile idiopathic arthritis. Am J Ophthalmol. 2007;143:647–55.

    Article  PubMed  Google Scholar 

  23. Thorne JE, Woreta F, Kedhar SR, Dunn JP, Jabs DA. Juvenile idiopathic arthritis-associated uveitis: Incidence of ocular complications and visual acuity loss. Am J Ophthalmol. 2007;143:840–6.

    Article  PubMed  Google Scholar 

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Funding

This study is funded by Children’s Hospital Ophthalmology Foundation.

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Authors and Affiliations

  1. Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Elisah Huynh, Abdelrahman M. Elhusseiny & Bharti R. Nihalani

  2. Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little rock, AR, USA

    Abdelrahman M. Elhusseiny

Authors
  1. Elisah Huynh
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  2. Abdelrahman M. Elhusseiny
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Contributions

All the authors were responsible for designing the review protocol, writing the protocol and manuscript, conducting the search, extracting and analyzing data, interpreting results, updating reference lists and creating’Summary of findings’ tables.

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Correspondence to Bharti R. Nihalani.

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Huynh, E., Elhusseiny, A.M. & Nihalani, B.R. Paediatric anterior uveitis management in the USA: a single-centre, 10-year retrospective chart review exploring the efficacy and safety of systemic immunomodulatory therapy. Eye 37, 1325–1330 (2023). https://doi.org/10.1038/s41433-022-02121-3

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