Uveitis is the leading cause of acquired childhood blindness with a prevalence of 30 cases per 100,000 inhabitants. There are multiple causes ; nevertheless, there is no standardized etiological assessment. The goal of our study is to define an epidemiological and clinical profile of uveitis diagnosed in a university hospital and their course when treated with anti-tumor necrosis factor (TNF) α.
All cases of uveitis under 18 years old, from 1994 to 2016, were included. Post-traumatic, post-surgical, pseudo-uveitis and retinopathy of prematurity were excluded. Demographic data, patient history, initial ophthalmological status, etiologic assessment data and treatments already underway were collected.
Ninety cases of pediatric uveitis were included, among which were 16.7 % infectious uveitis, 38.9 % inflammatory uveitis and 44.4 % idiopathic uveitis. Etiologic investigations were considered incomplete in 45 % of idiopathic uveitis cases. Treatment with anti-TNFα was selected for 15.5 % of patients. In total, 33 % of patients treated with etanercept required other anti-TNFα drugs due to a lack of control of inflammation. Infliximab and adalimumab successfully managed to control inflammation in 28.6 % of cases each.
Diagnostic criteria based adult systemic disease are sometimes inappropriate for children. The advent of anti-TNFα appears to improve the visual prognosis of inflammatory uveitis resistant to conventional immunosuppressant therapy, but we still need to perfect protocols for their use.
There are neither standardized etiological assessment nor clear diagnostic and therapeutic protocols for children. TNFα inhibitors are more effective in controlling inflammation in severe pediatric uveitis.