Abstract
Purpose :
To describe the presenting characteristics and the natural course of inflammatory papillitis in pediatric patients with uveitis.
Methods :
Observational, retrospective chart review of patients referred to a single tertiary care uveitis specialist in 1 year. Appropriate descriptive statistics for demographics, clinical characteristics, common etiologies, treatment regimens, and outcomes at 1 year were summarized.
Results :
Of 37 pediatric patients (47 eyes), 54% were female with an average age of 12.3 years (SD 5.58). 19 eyes (32%) in 12 patients had optic disc edema (inflammatory papillitis). Of these, 75% were female. Patients with inflammatory papillitis mostly presented with anterior uveitis (68%) and panuveitis (21%), while patients without papillitis mostly presented with anterior uveitis (64%) and intermediate uveitis (8%). The most common etiologies of uveitis in patients with inflammatory papillitis were tubulointerstitial nephritis and uveitis syndrome (33%) and Juvenile Idiopathic Arthritis (17%); 50% were deemed idiopathic. The most common etiologies in patients without papillitis were TINU (8%) and JIA (8%); 56% were deemed idiopathic. Presenting visual acuity (VA) was worse in eyes with inflammatory papillitis compared to those without (20/50 and 20/40 respectively, p=0.0394).
1-year follow up data was available for 12 eyes with papillitis at time of referral (8 patients) and 25 eyes (18 patients) without papillitis. Rates of immunomodulatory therapy (IMT) at referral were similar between cohorts: 2 (17%) patients with papillitis were on IMT compared to 4 patients (16%) without (p=0.887). All patients with initial papillitis were on IMT at 1 year follow up, compared to 44% of patients without papillitis (p=0.006). Similarly, 5 patients with initial papillitis (63%) were on dual IMT at 1 year, compared to only 2 patients (11%) without papillitis (p=0.008). VA in patients with initial papillitis remained around 20/50 at 1 year and did not differ significantly from referral VA (p=0.416). VA in patients without papillitis remained around 20/40 and did not differ significantly from referral VA (p=0.181).
Conclusions :
Inflammatory papillitis in pediatric uveitis may be more frequently associated with certain etiologies or forms of uveitis. Patients with papillitis are more likely to require IMT during their course than those without. However, these patients may not experience significant improvement in VA at 1 year.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.