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Vincent Y. Ho, Sheila Angeles-Han, G B. Hubbard, III, Steven Yeh; Pediatric Uveitis Disease Characteristics And Management In A University-based, Academic Practice. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1250.
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Pediatric uveitis care is challenging and often requires multiple providers including pediatric ophthalmology, rheumatology, uveitis, and vitreoretinal specialists. The study aims to describe baseline visual morbidity, disease associations, ocular complications, and the management of pediatric uveitis patients from a university-based academic referral center in the Southeast United States.
Retrospective study of patients treated at the Emory Eye Center (EEC) with noninfectious pediatric uveitis from September 2010-present. Demographic information, anatomic classification, systemic diseases, time to referral, baseline visual acuity (VA), ocular inflammation, secondary complications, prior treatments, and management strategies following transfer of care were reviewed.
Data from 72 eyes (44 patients) were reviewed from the EEC. The mean time to referral 66.5 weeks (Range 1-312 weeks). The mean age was 7.9 years (Range 2-17 years). 67% of patients had bilateral disease and 61% of patients were female. Systemic disease associations were identified in 71% of patients. Presenting VA was 20/40 or poorer in 46% of patients. Anterior uveitis was identified most frequently (50% of eyes), followed by intermediate (35%), posterior (3%) and panuveitis (13%). Secondary complications were frequent and included posterior synechiae (39%), band keratopathy (15%), and cataracts (29%). Escalation or initiation of systemic immunosuppression was elected as the initial management decision in 82% of patients. Immunosuppressive medications used included methotrexate (73%), infliximab (11%), adalimumab (5%) and mycophenolate mofetil (2%). Periocular corticosteroids were elected as the initial therapeutic strategy in a minority of cases (11%).
Moderate to severe visual impairment was observed in almost 50% of eyes at referral. Secondary complications were common, potentially reflecting significant duration of time prior to referral. Systemic immunosuppression was initiated or escalated at the initial uveitis appointment in the majority of patients. Longitudinal follow-up of outcomes will be needed to determine whether subtypes of pediatric uveitis respond better to local compared to systemic therapies.
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