Prevalence, Treatment Patterns, and Outcomes of Pediatric Noninfectious Uveitis in the United States: An IRIS Registry Analysis.

PURPOSE: To describe the prevalence, characteristics, and treatment patterns of pediatric noninfectious uveitis in the United States.

DESIGN

Retrospective database study.

SUBJECTS: Patients with noninfectious uveitis diagnosed and treated at age ≤18 years with ≥1 year follow-up identified in the IRIS® (Intelligent Research in Sight) Registry between January 1, 2013, and December 31, 2019.

METHODS

Mean annual prevalence of pediatric noninfectious uveitis was estimated overall and by anatomic location. Demographic information such as age, sex, race, ethnicity, and insurance status, along with types of anti-inflammatory medications, was evaluated. The Wilcoxon signed-rank test was used to compare distributions of visual acuity at baseline, 1 year, and final visits. Rates of ocular complications and surgeries among eyes with different anatomic locations of uveitis were compared using the chi-square test.

MAIN OUTCOME MEASURES: Annual prevalence, demographic characteristics, ocular complications, need for ocular surgery, type of anti-inflammatory medications, and difference in visual acuity (VA, logarithm of the minimum angle of resolution) at presentation, 1 year, and final visit (≥15 months).

RESULTS

A total of 5722 pediatric patients (9073 eyes) were identified, representing 2.1% of all patients with noninfectious uveitis in the IRIS Registry. Annual prevalence was 11.9 cases per 100 000 patients. The mean (standard deviation) age at diagnosis was 12.5 (4.0) years, 51.3% were female, 56.3% were White, 46.2% had private insurance, and 28.6% had Medicaid. Anatomical subtypes of uveitis included anterior (68.7%), intermediate (13.4%), posterior (6.1%), and panuveitis (10.2%). Mean VA ± standard deviation was 0.26 ± 0.37 at diagnosis, 0.18 ± 0.31 at 1 year (P < 0.001), and 0.21 ± 0.36 (P < 0.001) at final visit with a mean (standard deviation) follow-up of 1216 (579) days. Eight hundred forty-four (9.3%) eyes had severe vision loss (VA ≥1.00) during follow-up. Complications occurred in 1875 (20.7%) eyes, mostly as cataract (10.6%) and macular edema (5.4%), and 479 (5.3%) required ocular surgery. The highest rate of complications and ocular surgeries was seen in patients with panuveitis and posterior uveitis, respectively. Local corticosteroids were used in 5231 (91.4%), and 2467 (43.1%) were started on steroid-sparing agents after diagnosis, most commonly methotrexate (30.9%).

CONCLUSION

Annual prevalence of pediatric noninfectious uveitis in the United States per the IRIS Registry is 11.9 cases per 100 000 patients. It represents 2.1% of all noninfectious uveitis. Most patients are White and have anterior uveitis. Unlike adults with uveitis, there is no strong sex predilection. Mean VA improved significantly 1 year after diagnosis, but 9.3% of eyes had severe vision loss. The anatomic subtype of uveitis significantly affected visual outcomes, complications, and the need for ocular surgery. Methotrexate was the most commonly used steroid-sparing immunosuppressive agent. Although complications occurred, patients rarely underwent ocular surgery.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.