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. 2024 Jul 17;14(1):34.
doi: 10.1186/s12348-024-00415-z.

Paediatric Uveitis - the uniqueness in clinical presentation and the efficacy of biologics treatment

Mei Kwan Yiu  1 , Mary Ho  2 , Assunta C H Ho  3 , Winnie K Y Chan  4 , Wing Yung  1 , Wilson W K Yip  1 , Alvin L Young  1
Affiliations

Paediatric Uveitis - the uniqueness in clinical presentation and the efficacy of biologics treatment

Mei Kwan Yiu et al. J Ophthalmic Inflamm Infect. .

Abstract

Aims: To evaluate unique clinical characteristics of paediatric uveitis in our locality and treatment outcomes especially the efficacy of biologics.

Methods: This was a retrospective cohort.

Results: 37 paediatric uveitis cases involving 67 eyes were included. Male-to-female ratio was 1:1.3. Mean age of uveitis onset was 11 ± 3.7 (4-18). 81.1% cases suffered from bilateral uveitis. 75.7% cases were chronic uveitis. Nearly half of the cases (40.5%) presented with anterior uveitis. The predominant diagnosis of uveitis in our cohort was idiopathic. Unlike studies from other populations, the associated systemic conditions in this mostly Chinese cohort were Behçet's disease (8.1%), tubulointerstitial nephritis and uveitis (8.1%) and HLA-B27 associated uveitis (8.1%). Steroid response was a common phenomenon, observed in 40.5% of cases. The most common complication was posterior synechiae (45.9%), followed by cataract (37.8%), glaucoma (27.0%), band keratopathy (18.9%) and macular oedema (13.5%). 3/37 patients encountered either first attack of uveitis or flare after receiving COVID-19 vaccine. 54.1% of patients required systemic steroid for disease control. The majority required steroid sparing immunotherapy, including Methotrexate (43.2%), Mycophenolate Mofetil (24.3%), Cyclosporine A (8.1%), Azathioprine (5.4%) and Tacrolimus (2.7%). Resistant cases required biologics including tumour necrosis factor alpha inhibitors (Adalimumab 32.4%, Infliximab 2.7%) and interleukin-6 inhibitors (Tocilizumab 2.7%).

Conclusions: Clinical presentation of the local paediatric uveitis differs from previously described features in Caucasian and other populations. According to our experience as a tertiary eye centre, Behçet's disease, tubulointerstitial nephritis and uveitis and HLA-B27 associated uveitis were more often encountered than Juvenile Idiopathic Arthritis associated uveitis. Our report evaluated the efficacy of immunomodulatory therapy and biologics in controlling uveitis and reducing ocular complications.

Keywords: Biologics; Immunosuppressants; Paediatric uveitis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Age distribution of our cohort
Fig. 2
Fig. 2
a Baseline visual acuity of our cohort at presentation b Visual acuity after treatment
Fig. 3
Fig. 3
Slit lamp photos and OCT macular scans showing various clinical presentations in our cohort of paediatric uveitis a. A case of subacute anterior uveitis showing granulomatous keratic precipitates b. Slit lamp photo showing inferior broad peripheral anterior synechiae c. Slit lamp photo showing iris bombé d. Slit lamp photos of bilateral severe anterior uveitis showing 360-degree posterior synechiae e. Slit lamp photos showing peripapillary membrane in addition to seclusion pupillae f. Optical coherence tomography scan showing cystoid macular oedema
See this image and copyright information in PMC

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