Systemic Immunosuppression for the Treatment of Pediatric Uveitis

Abstract

Pediatric uveitis is uncommon, accounting for only 5% to 10% of all uveitis cases. 1 Similar to adults, children with uveitis may be asymptomatic or may present with eye pain, redness, photophobia, and blurry vision. 2 Uveitis can be categorized as anterior uveitis, intermediate uveitis, posterior uveitis, or panuveitis, depending on the part of the eye that is involved. 2,3 Diagnosis is made by examination; findings include anterior chamber (AC) cell and flare, AC fibrin, keratic precipitates, posterior iris synechiae, vitreous cell and haze, vitreous exudates (snowballs), chorioretinitis, and/or retinal vasculitis. 2 AC cell and flare can be graded based on the Standardization of Uveitis Nomenclature Criteria. 2 Complications of uveitis are extensive, including cataracts, glaucoma, hypotony, macular edema, epiretinal membrane, optic disc edema, band keratopathy, posterior synechiae, vision loss, and even permanent blindness. 2,4 Juvenile idiopathic arthritis (JIA) is the most common cause of secondary uveitis in children, with a reported incidence of 4.9 to 6.9 per 100,000 persons per year. 1,5 It is associated with chronic anterior uveitis in 10% to 30% of JIA patients. 2,4 While the majority of patients with JIAassociated uveitis maintain a good best-corrected visual acuity of 20/40 or better, 1 systematic review found that 9.4% of patients with JIA-associated uveitis had a best-corrected visual acuity worse than 20/40. 6 In addition, the incidence of cataracts was 20.5%, glaucoma was 18.9%, and band