Earlier use of systemic immunosuppression is associated with fewer ophthalmic surgeries in paediatric non-infectious uveitis

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.