Abstract
Purpose: :
To describe demographics and treatment outcomes of pediatric uveitis in a tertiary eye center in northern NJ.
Methods: :
Medical records of 102 pediatric uveitis patients (age <18 years at diagnosis) referred to the ocular immunology and uveitis service of New Jersey Medical School from 2000 to 2010 were reviewed retrospectively.
Results: :
61 (59.8%) of 102 patients were female. Median age at diagnosis was 9 years (range, 0.5-18). Median age at referral was 10.4 years (range, 2.8-23.8). Mean duration from diagnosis to referral was 25.5 months. Most patients were diagnosed at age of 6-10 years (42, 41.2%). Mean follow-up time was 33.5 months (range, 0-155). Anterior uveitis predominates (67, 65.7%); panuveitis (27, 26.5%); intermediate (7, 6.9%); posterior (1, 1.0%). Bilateral uveitis represents 79.4% (81) of all cases; 93 patients (91.2%) had noninfectious uveitis. The course of uveitis was mostly chronic form in 87 cases (85.3%). The 2 most common initial symptoms causing pursuit of care were red eye (30/102, 29.4%), decreased vision (19/102, 18.6%). The leading diagnoses were juvenile idiopathic arthritis (including suspected)-related (40, 39.2%), idiopathic (33, 32.3%), and sarcoid (including suspected) (22, 21.6%). A step-ladder algorithm of steroid-sparing immunomodulatory therapy was employed in chronic cases of noninfectious uveitis. Methotrexate was used in 103 either single or combined trials, of which 60 (58.3%) achieved complete control of inflammation with mean length of treatment 22.4 months, adverse events (AE) occurred in 11(10.7%) with transient reversible increases in AST/ALT (5) and GI upset (3); Infliximab total 34 with successes in 32 (94.1%), 25.1 months, and 3 AEs (8.8%); Adalimumab total 14 with successes in 12 (85.7%), 26.7 months, and no AE. Ocular surgery was required in 23 children (22.6%). Prevalence of legal blindness (≤ 20/200 in the better eye) was 1/102(1.0%) at baseline, and 0 afterwards; ≤ 20/100 was 4/102 (3.9%) at baseline, 1/76(1.3%) at 6-month, 0/63 at 1-year, 1/48(2.1%) at 3-year, and 2/30(6.7%) at 5-year; >20/50 was 92/102(90.2%) at baseline, 70/76(93.3%) at 6-month, 56/63(88.9%) at 1-year, 46/48(95.8%) at 3-year, and 27/30(90.0%) at 5-year.
Conclusions: :
Pediatric uveitis most commonly seen in northern NJ over last decade was characteristic of autoimmune associated, noninfectious, bilateral, chronic, anterior uveitis with the highest diagnosis rate at primary school ages. Immunomodulatory therapy tailored at individual bases proved to be safe and effective treatment for such group. Majority (>88%) of our patients retained vision of >20/50 at any given follow-up time.
Keywords: uveitis-clinical/animal model • clinical (human) or epidemiologic studies: prevalence/incidence • inflammation