Oh Lawrence J, Nguyen Chu L, Phan Kevin, Wong Eugene, Zagora Sophia, Singh-Grewal Davinder, Chaitow Jeffrey, Grigg John R, McCluskey Peter
Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia.
Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.
Clin Exp Ophthalmol. 2019 Aug;47(6):741-748. doi: 10.1111/ceo.13494. Epub 2019 Mar 27.
Paediatric uveitis is a severe sight-threatening uveitis due to disease progression and treatment failure. Biological agents are a promising new treatment. This study provides real-world data on their use from Sydney, Australia.
Traditionally corticosteroids and non-biological immunosuppressive agents were used to treat paediatric uveitis, often with poor outcomes.
Retrospective, chart review over an 8-year period at a tertiary referral eye hospital.
A total of 27 paediatric uveitis patients treated with biological agents.
Chart review of demographic data and treatment outcomes.
Treatment efficacy (corticosteroid-sparing effect, topical steroid cessation/reduction, reduction in systemic-steroid sparing agents, change in intraocular inflammation, visual acuity and central macular thickness); treatment failure; and adverse events. Data were collected at biological initiation, 6 weeks, 6 months and 12 months.
Biological therapy over 1 year was effective with prednisolone dose reduced to <5 mg/day in five of six patients (83%), number of systemic steroid-sparing agents was reduced to ≤1 in two of four patients (50%) and cessation of topical steroid achieved in 12/41 of eyes (29%). Improvement of anterior chamber cells by two grades occurred in 20/25 eyes (80%), improvement of logMAR to ≤0.3 occurred in 12/18 eyes (67%) and macular oedema decreased in 4/5 eyes (80%). Treatment failure occurred in six eyes (13.01%) and five patients (18.5%) developed an adverse reaction.
Biological therapy was effective in paediatric patients with uveitis. Intraocular inflammation improved with maintained visual acuity, systemic corticosteroid dose decreased and there was a low frequency of adverse events.
儿童葡萄膜炎是一种因疾病进展和治疗失败而严重威胁视力的葡萄膜炎。生物制剂是一种有前景的新治疗方法。本研究提供了来自澳大利亚悉尼关于其使用的真实世界数据。
传统上，皮质类固醇和非生物免疫抑制剂用于治疗儿童葡萄膜炎，疗效往往不佳。
在一家三级转诊眼科医院进行为期8年的回顾性病历审查。
共有27例接受生物制剂治疗的儿童葡萄膜炎患者。
对人口统计学数据和治疗结果进行病历审查。
治疗效果（皮质类固醇节省效应、局部类固醇停用/减量、全身类固醇节省剂减量、眼内炎症变化、视力和中心黄斑厚度）；治疗失败；以及不良事件。在开始使用生物制剂时、6周、6个月和12个月收集数据。
超过1年的生物治疗有效，6例患者中有5例（83%）泼尼松龙剂量降至<5mg/天，4例患者中有2例（50%）全身类固醇节省剂数量降至≤1，41只眼中有12只（29%）停用局部类固醇。25只眼中有20只（80%）前房细胞改善两级，18只眼中有12只（67%）logMAR改善至≤0.3，5只眼中有4只（80%）黄斑水肿减轻。6只眼（13.01%）治疗失败，5例患者（18.5%）出现不良反应。
生物治疗对儿童葡萄膜炎患者有效。眼内炎症改善，视力保持，全身皮质类固醇剂量降低，不良事件发生率低。
