Paediatric uveitic cataract and glaucoma in the time of biologic therapy

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.