Outcome of Treating Pediatric Uveitis With Dexamethasone Implants

Tomkins-Netzer, Oren; Talat, Lazha; Seguin-Greenstein, Sophie; Bar, Asaf; Lightman, Sue

doi:10.1016/j.ajo.2015.09.036

Cited by 35 publications

(23 citation statements)

References 19 publications

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“…The adverse events were similar to those identified in adult studies. These effects were supported by other series that showed that repeated implantations resulted in continued control of the inflammation, allowing a reduction of systemic immunosuppression with few ocular complications 31, 32 . However, more data are required to establish the long-term safety of the implants in the pediatric age group.…”

Section: Corticosteroid Implantssupporting

confidence: 53%

Recent advances in managing and understanding uveitis

Chen

Sheu

2017

F1000Res

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Uveitis is a sight-threatening disease entity with intraocular inflammation that arises from various causes. It mainly affects working-age individuals and may lead to irreversible visual loss if not treated properly in a timely manner. This article reviews recent advances in the management and understanding of uveitis since 2014, including treatment with new immunosuppressive therapies that use biological agents, local therapy with steroid implants, and imaging studies for the evaluation of uveitis.

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Section: Corticosteroid Implantssupporting

confidence: 53%

Recent advances in managing and understanding uveitis

Chen

Sheu

2017

F1000Res

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“…While systemic side-effects are minimized, local TA injections in the pediatric population often require general anesthesia, which poses its own risk to the patient. Moreover, the relatively short duration of action necessitates frequent repeat injections (23). Longer duration intraocular therapy includes Dexamethasone implant (Ozurdex) and 0.59 mg Fluocinolone acetonide implant (Retisert)(23–28).…”

Section: Treatmentmentioning

confidence: 99%

“…Moreover, the relatively short duration of action necessitates frequent repeat injections (23). Longer duration intraocular therapy includes Dexamethasone implant (Ozurdex) and 0.59 mg Fluocinolone acetonide implant (Retisert)(23–28). Ozurdex implantation lasts 6 months whereas Retisert implantation lasts for nearly 3 years, which reduces the overall risk associated with anesthesia compared to repeat TA injections (24, 26).…”

Section: Treatmentmentioning

confidence: 99%

“…Intravenous (IV) corticosteroids are occasionally used in cases of severe ocular inflammation, including Behcet’s disease, serpiginous choroiditis, or uveitis with optic nerve involvement (2). However, long-term use of systemic steroids has potential adverse effects in the pediatric patient that include growth retardation, hyperglycemia, weight gain, hypertension, osteoporosis, peptic ulcers, cataracts and glaucoma (23, 24). …”

Section: Treatmentmentioning

confidence: 99%

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An Update on Treatment of Pediatric Chronic Non-infectious Uveitis

Sood

Angeles‐Han

2017

Curr Treat Options in Rheum

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Opinion Statement There are no standardized treatment protocols for pediatric non-infectious uveitis. Topical corticosteroids are the typical first-line agent, although systemic corticosteroids are used in intermediate, posterior and panuveitic uveitis. Corticosteroids are not considered to be long-term therapy due to potential ocular and systemic side effects. In children with severe and/or refractory uveitis, timely management with higher dose disease-modifying antirheumatic drugs (DMARDs) and biologic agents is important. Increased doses earlier in the disease course may lead to improved disease control and better visual outcomes. In general, methotrexate is the usual first-line steroid-sparing agent and given as a subcutaneous weekly injection at >0.5 mg/kg/dose or 10–15 mg/m2 due to better bioavailability. Other DMARDs, for instance mycophenolate, azathioprine, and cyclosporine are less common treatments for pediatric uveitis. Anti-tumor necrosis factor-alpha agents, primarily infliximab and adalimumab are used as second line agents in children refractory to methotrexate, or as first-line treatment in those with severe complicated disease at presentation. Infliximab may be given at a minimum of 7.5 mg/kg/dose every 4 weeks after loading doses, up to 20 mg/kg/dose. Adalimumab may be given up to 20 or 40 mg weekly. In children who fail anti-tumor necrosis factor-alpha agents, develop anti-tumor necrosis factor-alpha antibodies, experience adverse effects, or have difficulty with tolerance, there is less data available regarding subsequent treatment. Promising results have been noted with tocilizumab infusions every 2–4 weeks, abatacept monthly infusions and rituximab.

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“…Dexamethasone intravitreal implants are used in intermediate and posterior uveitis with low rates of development of cataracts and increased IOP [35]. Henderson examined data from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry, a registry of patients with pediatric rheumatic disease in North America, to examine practice patterns of pediatric rheumatologists [36*].…”

Section: Introductionmentioning

confidence: 99%

Uveitis in children

Angeles‐Han

Rabinovich

2016

Current Opinion in Rheumatology

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Purpose of review-This review provides updates on novel risk markers for the development of pediatric inflammatory uveitis and a severe disease course, on treatment of refractory disease, and on the measurement of visual outcomes.Recent findings-There are several new genetic markers, biomarkers and clinical factors that may influence a child's uveitis disease course. It is important to identify children at risk for poor visual outcomes and who are refractory to traditional therapy. Racial disparities have recently been reported. We describe agents of potential benefit. In addition, we discuss the importance of patient reported outcomes in this population.Summary-Uveitis can lead to vision threatening complications. Timely and aggressive treatment of children identified to be at risk for a severe uveitis course may lead to improved outcomes.

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Outcome of Treating Pediatric Uveitis With Dexamethasone Implants

Cited by 35 publications

References 19 publications

Recent advances in managing and understanding uveitis

Recent advances in managing and understanding uveitis

An Update on Treatment of Pediatric Chronic Non-infectious Uveitis

Uveitis in children

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