Abstract
Purpose :
To characterize the breadth of pediatric uveitis seen at a major tertiary referral center in the Southeast, and to describe the initial agent of choice in the era of biologic therapy.
Methods :
Retrospective chart review of 260 patients ages 0 to 18 seen at Emory Eye Center between 2008 and 2018 with a diagnosis of uveitis. Patients were divided into four anatomic subgroups and analysis was performed looking at demographic distributions. The imaging studies of the patients were reviewed. Patients were also evaluated on systemic treatments they received; corticosteroids only, antimetabolites, and TNF-alpha inhibitors.
Results :
Over the 10 year period, we recorded 260 patients with pediatric uveitis. The mean age at first visit was 12, with 119 (46%) patients being male and 141 (54%) being female. 169 (65%) of patients had bilateral involvement. Anterior uveitis was the most common anatomic location with 169 (65%) cases, and the most common systemic association in our cohort was Juvenile Idiopathic Arthritis with 65 cases (25%). Idiopathic cases accounted for 116 (45%) of patients. Of the 260 individuals, 106 (41%) were on systemic glucocorticoids over the course of treatment, 127 (49%) were treated with systemic antimetabolites, and 82 (32%) were treated with systemic TNF-alpha inhibitors. Of the 82 patients started on biologic therapy, 56 (68%) were treated with adalimumab, 2 (2%) on etanercept, and 43 (52%) on infliximab. The most common reason for an addition of a TNF-alpha inhibitor to a systemic antimetabolite therapy was treatment failure (74%). There was an average of 1.21 systemic medications used per patient including systemic glucocorticoids. Optical coherence tomography (OCT) was performed in 52% of eyes, fundus photography in 22% of patients, and fluorescein angiography in 22% of patients.
Conclusions :
The majority of pediatric uveitis cases were bilateral, noninfectious, and observed in females. JIA was the most common etiology in our cohort and systemic antimetabolites were preferred to TNF alpha inhibitors. Adalimumab was the most used biologic therapy with treatment failure being the primary indication. OCT was used frequently due to the ease and speed in young patients and was most often used to diagnose cystoid macular edema.
This is a 2020 ARVO Annual Meeting abstract.