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

PurposeTo evaluate the rate of ocular complications for pediatric uveitic patients, treated with anti-tumor necrosis factor-alpha (TNF-alpha) agents.MethodsRetrospective study of pediatric patients with non-infectious chronic anterior uveitis, treated with anti-TNF-alpha 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.ResultsThe 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-alpha 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).ConclusionsTimely employment of anti-TNF-alpha agents to treat pediatric non-infectious anterior uveitis may improve outcomes, maintain inflammatory control, and reduce rate of complications.