June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Paediatric uveitic cataract and glaucoma in the time of biologic therapy
Author Affiliations & Notes
  • Sophia L Zagora
    Save Sight Institute, Ophthalmology, The University of Sydney, Sydney, New South Wales, Australia
    Paediatric Ophthalmology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
  • Tanya Karaconji
    Save Sight Institute, Ophthalmology, The University of Sydney, Sydney, New South Wales, Australia
    Paediatric Ophthalmology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
  • Davinder Singh-Grewal
    Paediatric Rheumatology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
    The University of Sydney School of Medicine, Sydney, New South Wales, Australia
  • Jeff Chaitow
    Paediatric Rheumatology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
  • Robyn Jamieson
    Genetics, Children's Hospital at Westmead, Westmead, New South Wales, Australia
    Save Sight Institute, Ophthalmology, The University of Sydney, Sydney, New South Wales, Australia
  • Peter J McCluskey
    Save Sight Institute, Ophthalmology, The University of Sydney, Sydney, New South Wales, Australia
  • John R Grigg
    Save Sight Institute, Ophthalmology, The University of Sydney, Sydney, New South Wales, Australia
    Paediatric Ophthalmology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
  • Footnotes
    Commercial Relationships   Sophia Zagora, None; Tanya Karaconji, None; Davinder Singh-Grewal, None; Jeff Chaitow, None; Robyn Jamieson, None; Peter McCluskey, None; John Grigg, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1410. doi:
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      Sophia L Zagora, Tanya Karaconji, Davinder Singh-Grewal, Jeff Chaitow, Robyn Jamieson, Peter J McCluskey, John R Grigg; Paediatric uveitic cataract and glaucoma in the time of biologic therapy. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1410.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Uveitis is a rare chronic condition, “orphan disease” in the paediatric population. The incidence is 4.3 per 100,000 and prevalence 27.9 per 100,000. It is sight threatening due to disease progression and treatment failure. The mainstay of uveitis treatment is steroids. Steroid induced cataract and glaucoma is well documented and has been found to account for a quarter of all acquired glaucoma in children. Steroid sparing agents and biologic therapy (genetically engineered proteins targeting specific parts of the immune system that cause inflammation) are increasingly being used. The purpose of this study is to investigate rates, timing and visual outcomes of paediatric uveitic cataract and glaucoma surgery in relation to the treatment of the uveitis with biologic therapy and steroid sparing immunosuppression.

Methods : Retrospective chart review of demographic data and treatment outcomes of all paediatric uveitis patients presenting to the Children’ s Hospital Westmead, Sydney Eye Hospital and Save Sight Institute from 2005- 2020.

Results : Pilot data highlights that there were 115 patients (207 eyes) diagnosed with paediatric uveitis during this period. The majority had bilateral uveitis (n = 100, 80%). 64 patients were female and 51 patients male. The most common aetiological diagnosis was JIA-U (n = 77, 67%), followed by idiopathic uveitis (n = 34, 29.6%). Anatomical diagnosis was 84% anterior uveitis and 16% non-anterior uveitis. Cataract surgery was required in 46 patients / 40% (61 eyes / 29.4%); glaucoma surgery - trabeculectomy or tube surgery in 40 patients / 34.7% (49 eyes / 23.7%). A number of patients underwent multiple surgeries. The mean duration of inflammation prior to commencement of a biological agent was 22.0 months (range: 1-48 months). Baseline age at commencement of biologic therapy was 9.12 years (3.42 SD). Of those patients on biologic therapy, the baseline VA was logMAR 0.24 (0.34 SD) and final VA was logMAR 0.18 (0.28 SD) with a mean change in VA from baseline of logMAR -0.07 (0.23 SD).

Conclusions : Paediatric uveitis is a complex disease. The advent of biologic therapy and other steroid sparing agents, in this real world data, are having beneficial effects on visual outcome, uveitic cataract and glaucoma surgery in these patients.

This is a 2021 ARVO Annual Meeting abstract.

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