Pediatric Uveitis: Changes in Treatment Trends and Outcomes in 1980s and 1990s

Abstract

Purpose: : To evaluate the changes in treatment trends and to compare visual outcomes and complications of two cohorts of pediatric uveitis patients: those treated in 1980s or before and 1990s or after.

Methods: : A retrospective cohort of 521 patients with pediatric uveitis between the ages of 0-18 years seen at the National Eye Institute, University of Illinois-Chicago, and Oregon Health and Science University was analyzed. Visual outcomes, complications and treatments were compared.

Results: : The cohort was divided by date of first visit; 1980’s cohort (N=61) and 1990’s cohort (N=461). Treatments utilized in 1980’s and 1990’s cohorts were as follows: systemic steroids: 30.6% vs 43.6%; NSAIDs: 4.8% vs 14.2%; conventional immunosuppressives (antimetabolites, T-cell inhibitors, cytotoxic agents): 4.8% vs 29.9%; and biologics: 0% vs 6.7%. Proportion of patients undergoing ocular surgery was 11.3% in 1980’s cohort compared to 21.4% in 1990’s cohort. Proportion of patients with visual acuity of ≥20/40 was 35% in 1980’s cohort and 44% in 1990’s cohort; VA ≤20/200 was 12% vs 7% in 1980’s and 1990’s cohorts respectively (p<0.43). Proportion of patients free of any anterior or posterior segment complications was similar in both cohorts (17.5% vs 16.6%) whereas patients with both anterior and posterior complications were higher in 1990’s cohort (36.5% in 1980’s and 44.7% in 1990’s cohort).

Conclusions: : Although there was a significant increase in the use of conventional and newer immunosuppressive treatments over the last decade and an overall trend toward better visual outcomes, changes in treatment trends over the last decade does not seem to result in a significant improvement in structural complications or outcomes in childhood uveitis. Prospective comparative studies may further elucidate these findings and help identify children most at risk.

Keywords: uveitis-clinical/animal model • uvea • inflammation