Purpose To describe demographics and treatment outcomes of pediatric uveitis in a tertiary eye center in northern NJ.
Methods Medical records of 122 pediatric uveitis patients (age <18 years at diagnosis) referred to the ocular immunology and uveitis service of New Jersey Medical School from 2000 to 2010 were reviewed retrospectively.
Results 75 (61.5%) of 122 patients were female. Median age at diagnosis was 9.0 years. Median age at referral was 10.4 years. Mean follow-up time was 34.0 months (range, 0-134.7). Anterior uveitis predominates (80, 65.6%); panuveitis (32, 26.2%); intermediate (9, 7.4%); posterior (1, 0.8%). Bilateral uveitis represents 75.4% (92); 111 patients (91.0%) had no infection present. Chronic were 103 (84.4%). The 2 most common initial symptoms causing pursuit of care were red eye (35, 28.7%), decreased vision (27, 22.1%). The leading diagnoses were JIA (46, 37.7%), idiopathic (39, 32.0%), and sarcoid (30, 24.6%). A step-ladder algorithm of immunomodulatory therapy was employed in chronic noninfectious cases. NSAIDS alone achieved complete control of inflammation in 7 out of 17 trials (41.2%) with mean length of treatment 10.4 months. Methotrexate alone succeeded 32/69 trials (46.4%), 24.1 months, adverse events (AE) occurred in 15 with transient increases in AST/ALT (7) and GI upset (4); Infliximab succeeded in 35/36 (97.2%), 27.7 months, and 2 AEs; Adalimumab 13/16 (81.3%), 20.9 months, and 3 AEs. Ocular surgery was required in 29 (23.8%). Prevalence of legal blindness (20/50 was 108/122(88.5%) at baseline, 69/79 (87.3%) at 1-year, 56/60 (93.3%) at 3-year, and 33/38 (86.8%) at 5-year.
Conclusions Majority of children with chronic noninfectious uveitis tolerated immunomodulators without drug-induced complications, and treatments effectively controlled ocular inflammation with >86% retained vision >20/50 throughout follow-up. |
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