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Earlier use of systemic immunosuppression is associated with fewer ophthalmic surgeries in paediatric non-infectious uveitis
  1. Crystal Sin Yi Cheung1,
  2. Kamiar Mireskandari2,
  3. Asim Ali2,
  4. Earl Silverman3,
  5. Nasrin Tehrani2
  1. 1Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
  2. 2Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3Department of Pediatric Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
  1. Correspondence to Dr Crystal Sin Yi Cheung, Boston Children s Hospital, Boston, MA 02115, USA; cheuncsy{at}gmail.com

Abstract

Background/aims There is a paucity of large trials investigating the effect of management strategies for paediatric non-infectious uveitis on complications requiring surgery. The purpose of our study is to investigate whether earlier initiation of systemic immunosuppression in paediatric non-infectious uveitis is associated with fewer ophthalmic surgeries.

Methods A retrospective review was conducted on 48 children with non-infectious uveitis assessed in 1998–2013. Patients were divided into uveitis diagnosed before December 2008 (group 1) and after January 2009 (group 2). Duration from uveitis onset to methotrexate initiation (U-MTX) and biological addition (U-Biologic) were reviewed. Follow-up visits with topical corticosteroids >3 times daily and active uveitis (≥1+ cells) during 3.5 years were documented. The main outcome measure was the need for ≥1 ophthalmic surgery at 3.5 years.

Results In group 1, 69.5% of patients required ≥1 ophthalmic surgery at 3.5 years versus 26.9% in group 2 (p=0.005). U-MTX was 28.9±11.8 weeks and 14.2±10.0 weeks for groups 1 and 2 (p=0.028). U-Biologic was 134.6±46.0 weeks and 82.3±43.3 weeks for groups 1 and 2 (p=0.0016). Corticosteroid use >3 times daily was 85.9±52.7 weeks and 14.6±11.1 weeks for groups 1 and 2. Multivariate regression showed methotrexate initiation within 6 months of uveitis onset lowered the likelihood of needing ophthalmic surgery at 3.5 years (OR=6.2, 95% CI 1.2 to 33.4; p=0.033). Univariate regression demonstrated biological addition within 18 months of uveitis onset reduced the likelihood of requiring ophthalmic surgery (OR 12.57, 95% CI 1.28 to 123.48; p=0.030).

Conclusion Earlier control of uveitis by addition of immunosuppressive therapy reduced the need for ophthalmic surgery.

  • inflammation
  • lens and zonules
  • glaucoma
  • immunology
  • treatment surgery
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Footnotes

  • Presented at Meeting presentations: The American Academy of Ophthalmology Annual Meeting, New Orleans, November 2017 (oral presentation), Canadian Ophthalmology Society Annual Meeting, Montreal, June 2017 (oral presentation), American Association for Pediatric Ophthalmology and Strabismus Annual Meeting, April 2017 (oral presentation).

  • Correction notice This paper has been corrected since it was published Online First. The affiliations have been updated.

  • Contributors I acknowledge that each coauthor has made a direct and substantial contribution to this study within their respective areas of expertise. They have participated to a sufficient degree to take responsibility for the work and accept its conclusion. All coauthors have read and approve of the final version of this manuscript. CSYC: study design, designed data collection tools, data collection, wrote the statistical analysis plan, cleaned and analyed the data, and drafted and revised the manuscript. KM and AA: study design, wrote the statistical analysis plan, analysed the data and revised the drafted manuscript. ES: initiated the collaborative project, study design, wrote the statistical analysis plan, analysed the data and revised the drafted manuscript. NT: initiated the collaborative project, study design, designed data collection tools, wrote the statistical analysis plan, analysed the data and revised the drafted manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on request.

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