Pediatric Uveitis: Impact of Anti-Tumor Necrosis Factor-Alpha on Ocular Complications.

Purpose: To evaluate the rate of ocular complications for pediatric uveitic patients, treated with anti-tumor necrosis factor-alpha (TNF-α) agents.

Methods: Retrospective study of pediatric patients with non-infectious chronic anterior uveitis, treated with anti-TNF-α at two tertiary uveitis centers. The primary outcome was the effect of therapy on ocular complications rate. Secondary outcomes included disease activity, achievement of steroid sparing effect and visual acuity.

Results: The cohort included 59 pediatric patients (115 eyes) with mean age of 6.6 ± 3.9 years. Most were females (50, 85%), Caucasians (49, 83%) with bilateral uveitis (56, 95%). The leading etiology was juvenile idiopathic arthritis-associated uveitis (36, 61%). Adalimumab was the most used medication (56 patients, 95%), with active uveitis being the most common indication for treatment (50 patients, 85%). The median interval between uveitis diagnosis and treatment initiation was 16.4 months (range 0.2-162). Anterior chamber cells and flare decrease was noted as early as 6 months after treatment initiation and remained stable throughout the follow-up period. Mean number of steroids drops per day decreased from 2.31 ± 2.4 at baseline to 0.62 ± 0.9, 0.60 ± 0.8, 0.55 ± 0.8, and 0.33 ± 0.6 at 1, 2, 3, and 5 years, respectively. In a multivariate analysis, longer interval between uveitis diagnosis and anti-TNF-α initiation was associated with an increased risk of developing ocular complications including cataract and glaucoma (HR = 1.02, p = 0.0004; HR = 1.04, p = 0.0002, per month, respectively).

Conclusions: Timely employment of anti-TNF-α agents to treat pediatric non-infectious anterior uveitis may improve outcomes, maintain inflammatory control, and reduce rate of complications.