Spectral Domain Optical Coherence Tomography Outcomes in Pediatric Uveitis Patients Treated with Adalimumab

Abstract

Purpose : Multimodal imaging has been an essential part of the diagnosis and management of pediatric uveitis. This study aims to examine the utility of spectral domain optical coherence tomography (SD-OCT) alone as a surrogate for clinical response in pediatric uveitis patients on adalimumab.

Methods : This is an IRB-approved, retrospective, consecutive case series. Pediatric patients treated with adalimumab and diagnosed with non-infectious uveitis with at least a 12-month follow-up period with SD-OCT imaging taken at multiple time points were included in this study. Patients were classified as treatment-responsive, relative successes or absolute failures to adalimumab based on clinical exam activity. Treatment-responsive patients were inactive on clinical exam at 12-months, while relative successes improved, but were still clinically active. Patients were considered absolute failures if they had worsening disease and were active at 12-months or were switched to a different medication due to having limited or no response. Retinal layer segmentation was completed by an automated algorithm and metrics for total macular cube volume (mm³), central subfield thickness (CST, µm), total retinal fluid index (%), mid subfield fluid index (%) and central subfield fluid index (%) were obtained along with EZ-RPE central subfield mean thickness (µm) and ONL-RPE central subfield volume (mm³).

Results : A total of 99 eyes from 50 pediatric patients (28 female, 22 male) were analyzed with a mean age of 14.06 years (range, 7-20 years). At 12-months for treatment-responsive patients, all metrics decreased significantly (p<0.0001) vs baseline including mean total macular cube volume, retinal fluid index metrics, EZ-RPE central subfield mean thickness and ONL-RPE central subfield volume. There was a 15% significant decrease in the mean CST from baseline (323.5) to 12-months (275, p<0.0001). In those patients in the absolute failure group, there was no significant change from baseline to month 12 in the SD-OCT metrics.

Conclusions : SD-OCT metrics improved significantly in those patients who clinically responded to adalimumab. In those who failed adalimumab therapy, SD-OCT metrics did not improve. In this study, the lack of improvement on SD-OCT while on adalimumab therapy was associated with treatment failure. SD-OCT can be used as a marker of clinical response in those with pediatric uveitis treated with adalimumab.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.