Prevalence, Treatment Patterns, and Outcomes of Pediatric Non-Infectious Uveitis in the United States: An IRIS® Registry Analysis.

Purpose: To describe the prevalence, characteristics and treatment patterns of pediatric non-infectious uveitis in the United States (U.S.) DESIGN: Retrospective database study SUBJECTS: Patients with non-infectious uveitis diagnosed and treated at age ≤18 with ≥1 year follow-up identified in the Intelligent Research in Sight (IRIS®) Registry between January 1, 2013 and December 31, 2019.

Main outcome measures: Annual prevalence, demographic characteristics, ocular complications, need for ocular surgery, type of anti-inflammatory medications, and difference in visual acuity (VA, logMAR) 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 non-infectious uveitis patients in the IRIS Registry. Annual prevalence was 11.9 cases per 100 000 patients. Mean (SD) 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±SD 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 mean (SD) follow-up of 1216 (579) days. 844 (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 were 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 non-infectious uveitis in the U.S. per the IRIS Registry is 11.9 cases per 100 000 patients. It represents 2.1% of all non-infectious uveitis. Most patients are White and have anterior uveitis. Unlike adults with uveitis, there is not a strong gender 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 need for ocular surgery. Methotrexate was the most commonly used steroid-sparing immunosuppressive agent. Though complications occurred, patients rarely underwent ocular surgery.