Ocular Complication Rates Improved With Biologic Use in Noninfectious Pediatric Uveitis

Improvements in the rate of ocular complications and visual impairment have been noted in pediatric patients with noninfectious uveitis who are treated with biologic agents.

In pediatric patients with noninfectious uveitis, improvements in the rate of ocular complications and visual impairment have been noted in those who are treated with biologic agents, according to the results of a retrospective study published in Pediatric Rheumatology.

The investigators sought to delineate the clinical characteristics of children with noninfectious uveitis and to establish the visual outcomes and ocular complications linked to the condition. They identified pediatric patients diagnosed with noninfectious uveitis between January 2011 and December 2015. All data were compiled at baseline and at 1, 3, 5, and 10 years following the initial diagnosis. Incidence rates of structural ocular complications, visual impairment, and surgical intervention were calculated. Logistic regression analysis was used to explore the association between various baseline features and subsequent visual impairment.

A total of 166 children were included in the study. Among these, 60.2% had a systemic disease association. Overall, 72.9% of patients were treated with methotrexate and 58 of these children also received a biologic agent. Overall, a total of 678 person-years and 1216 eye-years of follow-up were available.

Children with juvenile idiopathic arthritis (JIA)-associated uveitis had a longer duration of follow-up compared with those with idiopathic uveitis (median of 5 years vs 3 years, respectively). Visual acuity was recorded in logMAR, which is a logarithmic representation of visual acuity. Rates of visual acuity loss over the observation period to >0.3 LogMAR and to ≥1.0 LogMAR among affected eyes were 0.05 per eye year and 0.01 per eye-year, respectively. At presentation, 34.6% of eyes had ≥1 ocular uveitis-associated complication, of which posterior synechiae was the most common (18.4%).

The rate of newly diagnosed band keratopathy and posterior synechiae was 0.02 per eye-year. Children with JIA-associated uveitis were significantly more likely to have elevated intraocular pressure and glaucoma compared with those with idiopathic uveitis (P =.05 and P =.002, respectively), whereas those with idiopathic uveitis were significantly more likely to have macular edema (P =.01) over the follow-up period. Cataract was the most common complication reported over the follow-up period, with an incidence of 0.05 per eye-year.

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The investigators concluded that compared with previously published data, the current study demonstrated an encouraging improvement in the rate of visual impairment and ocular complications in pediatric patients with noninfectious uveitis. Of note, the rate of biologic use was high at 34.9%, which is reflective of the increased use and importance of these agents in the management of patients with inflammatory disorders.

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Cann M, Ramanan AV, Crawford A, et al. Outcomes of non-infectious paediatric uveitis in the era of biologic therapy. Pediatr Rheumatol Online J. 2018;16(1):51.