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Spencer Cope, Aimee Hersh, Akbar Shakoor, John Bohnsack, Albert Vitale; Use of Immunosuppressive Medications for Treatment of Pediatric Intermediate Uveitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5201.
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© ARVO (1962-2015); The Authors (2016-present)
The optimal treatment strategy for pediatric patients with intermediate uveitis is not well known. The purpose of this study is to describe the demographics, clinical presentation, treatment, and outcomes of a cohort of pediatric patients with intermediate uveitis, with a particular focus on the use of immunosuppressive medications.
This retrospective cohort study included all pediatric intermediate uveitis patients treated in the Uveitis Clinic at the University of Utah Moran Eye Center from 1999-2012. Medical records were reviewed and data abstracted at specific time points including initial presentation, 6 months, 1 year, and then annually. Data abstracted included examination findings, disease related complications, and treatment including surgical interventions and immunosuppressive medications. Responsiveness was determined based on Standardization of Uveitis Nomenclature (SUN) definitions for grading inflammation, inactive disease, and remission. Summary statistics were used to describe this cohort.
The mean age at presentation was 7.7 years (SD 3.1), 56% of subjects were male, 95% had bilateral involvement. 36 subjects had idiopathic disease; 3 subjects had an underlying condition (juvenile idiopathic arthritis (n=2), multiple sclerosis (n=1)). Average length of follow-up was 37 months (range (6-96) months). Out of 76 total eyes involved, findings at presentation included: snowballs (n=48, 63%), snowbanks (n=38, 50%), vitreous debris (n=32, 42%), and visual acuity < 20/50 (n=43, 57%). The most frequent disease complications were hypertony (n=45, 59%), cataracts (n=38, 50%), cystoid macular edema (n=30, 39%), visual acuity < 20/50 (n=46, 61%) and visual acuity < 20/200 (n=20, 26%). Common surgical treatments included periocular steroid injection (n=25 subjects, 64%) and pars plana vitrectomy (n=10, 26%). Oral steroids were received by 17 subjects (44%), and Table 1 describes immunosuppressive medication and responses. Overall, 49 subjects (64%) had inactive disease at their final follow-up visit, and 9 subjects (23%) achieved remission after at least 3 months off all medications.
In this cohort, patients treated with immunosuppressive therapy had interval improvement in their degree of inflammation. Prospective studies are needed to determine the best therapy for this high risk population.
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