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Kellett S, Rahi JS, Dick AD, Knowles R, Tadić V, Solebo AL. UNICORNS: Uveitis in childhood prospective national cohort study protocol. F1000Res 2023; 9:1196. [PMID: 38435080 PMCID: PMC10905007 DOI: 10.12688/f1000research.26689.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 03/05/2024] Open
Abstract
Background: Childhood uveitis is a rare inflammatory eye disease which is typically chronic, relapsing-remitting in nature, with an uncertain aetiology (idiopathic). Visual loss occurs due to structural damage caused by uncontrolled inflammation. Understanding of the determinants of long term outcome is lacking, including the predictors of therapeutic response or how to define disease control. Aims: To describe disease natural history and outcomes amongst a nationally representative group of children with non-infectious uveitis, describe the impact of disease course on quality of life for both child and family, and identify determinants of adverse visual, structural and developmental outcomes. Methods: UNICORNS is a prospective longitudinal multicentre cohort study of children newly diagnosed with uveitis about whom a core minimum clinical dataset will be collected systematically. Participants and their families will also complete patient-reported outcome measures annually from recruitment. The association of patient (child- and treatment- dependent) characteristics with outcome will be investigated using logistic and ordinal regression models which incorporate adjustment for within-child correspondence between eyes for those with bilateral disease and repeated outcomes measurement. Discussion: Through this population based, prospective longitudinal study of childhood uveitis, we will describe the characteristics of childhood onset disease. Early (1-2 years following diagnosis) outcomes will be described in the first instance, and through the creation of a national inception cohort, longer term studies will be enabled of outcome for affected children and families.
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Affiliation(s)
- Salomey Kellett
- National Institute for Health Research Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, WC1N 1EH, UK
| | - Jugnoo S Rahi
- National Institute for Health Research Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, WC1N 1EH, UK
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, UK
- Ulverscroft Vision Research Group, Institute of Child Health, University College London, London, WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, UK
| | - Andrew D. Dick
- Ulverscroft Vision Research Group, Institute of Child Health, University College London, London, WC1N 1EH, UK
- Translational Health Sciences, Faculty of Health Sciences, University of Bristol, Bristol, BS8 1QU, UK
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, BS1 2LX, UK
| | - Rachel Knowles
- National Institute for Health Research Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, UK
| | - Valerija Tadić
- School of Human Sciences, University of Greenwich, Greenwich, London, SE10 9LS, UK
| | - Ameenat Lola Solebo
- National Institute for Health Research Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, WC1N 1EH, UK
- Ulverscroft Vision Research Group, Institute of Child Health, University College London, London, WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, UK
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Huynh E, Elhusseiny AM, Nihalani BR. Paediatric anterior uveitis management in the USA: a single-centre, 10-year retrospective chart review exploring the efficacy and safety of systemic immunomodulatory therapy. Eye (Lond) 2023; 37:1325-1330. [PMID: 35650322 PMCID: PMC10169791 DOI: 10.1038/s41433-022-02121-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/24/2022] [Accepted: 05/23/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of immunomodulatory therapy (IMT) in paediatric anterior uveitis. METHODS Chart review of all patients ≤ 18 years treated for anterior uveitis using a stepladder approach during a 10-year period. The type and duration of IMT were noted. The data were analysed depending on chronicity, aetiology, and type of IMT using appropriate statistical tests. The outcome measures included ocular complications, the need for surgical intervention, and visual outcomes. RESULTS One hundred and thirty-four patients (191 eyes) were analyzed. The median age at diagnosis was 7 years (interquartile range (IQR): 7.5 years). The median follow-up was 4 years (IQR: 6 years). The most common causes of anterior uveitis were Juvenile idiopathic arthritis (64 patients, 47.8%) and undifferentiated (33 patients, 24.6%). All patients were started on topical steroids and cycloplegics. 94 (70%) patients required IMT. 92 (68.6%) were started on Methotrexate as the first agent, of which 21 (22%) were switched to a different agent owing to side effects. Biologic agent was added in 55 (41%) patients. 21 (16%) required switch to a second biologic agent, 5 (3.7%) to third, and 1 (0.8%) to fourth biologic agent. At the last exam, 11 (8%) had persistent inflammation. 55 (41%) had ocular complications, and 113 (84%) had a best corrected visual acuity ≥ 20/40. CONCLUSION Early introduction of IMT and switch to different agents may be required to control anterior uveitis and reduce the complications in children. IMT is safe and effective in treating paediatric anterior uveitis.
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Affiliation(s)
- Elisah Huynh
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little rock, AR, USA
| | - Bharti R Nihalani
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Solebo AL, Kellett S, Rahi J, Pattani R, Edelsten C, Dick AD, Denniston A. Development of a Nationally Agreed Core Clinical Dataset for Childhood Onset Uveitis. Front Pediatr 2022; 10:881398. [PMID: 35799695 PMCID: PMC9253543 DOI: 10.3389/fped.2022.881398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Childhood onset uveitis comprises a group of rare inflammatory disorders characterized by clinical heterogeneity, chronicity, and uncertainties around long term outcomes. Standardized, detailed datasets with harmonized clinical definitions and terminology are needed to enable the clinical research necessary to stratify disease phenotype and interrogate the putative determinants of health outcomes. We aimed to develop a core routine clinical collection dataset for clinicians managing children with uveitis, suitable for multicenter and national clinical and experimental research initiatives. Methods Development of the dataset was undertaken in three phases: phase 1, a rapid review of published datasets used in clinical research studies; phase 2, a scoping review of disease or drug registries, national cohort studies and core outcome sets; and phase 3, a survey of members of a multicenter clinical network of specialists. Phases 1 and 2 provided candidates for a long list of variables for the dataset. In Phase 3, members of the UK's national network of stakeholder clinicians who manage childhood uveitis (the Pediatric Ocular Inflammation Group) were invited to select from this long-list their essential items for the core clinical dataset, to identify any omissions, and to support or revise the clinical definitions. Variables which met a threshold of at least 95% agreement were selected for inclusion in the core clinical dataset. Results The reviews identified 42 relevant studies, and 9 disease or drug registries. In total, 138 discrete items were identified as candidates for the long-list. Of the 41 specialists invited to take part in the survey, 31 responded (response rate 78%). The survey resulted in inclusion of 89 data items within the final core dataset: 81 items to be collected at the first visit, and 64 items at follow up visits. Discussion We report development of a novel consensus core clinical dataset for the routine collection of clinical data for children diagnosed with non-infectious uveitis. The development of the dataset will provide a standardized approach to data capture able to support observational clinical studies embedded within routine clinical care and electronic patient record capture. It will be validated through a national prospective cohort study, the Uveitis in childhood prospective national cohort study (UNICORNS).
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Affiliation(s)
- Ameenat Lola Solebo
- Population, Policy and Practice Programme, UCL GOS Institute of Child Health, London, United Kingdom
- National Institute for Health Research Biomedical Research Center at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
- Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
- *Correspondence: Ameenat Lola Solebo
| | - Salomey Kellett
- Population, Policy and Practice Programme, UCL GOS Institute of Child Health, London, United Kingdom
| | - Jugnoo Rahi
- Population, Policy and Practice Programme, UCL GOS Institute of Child Health, London, United Kingdom
- National Institute for Health Research Biomedical Research Center at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
- Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
- Ulverscroft Vision Research Group, Institute of Child Health, University College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Center at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Reshma Pattani
- Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Clive Edelsten
- Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Andrew D. Dick
- National Institute for Health Research Biomedical Research Center at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Translational Health Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Alastair Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation & Aging, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Siiskonen M, Hirn I, Pesälä R, Hautala T, Ohtonen P, Hautala N. Prevalence, incidence and epidemiology of childhood uveitis. Acta Ophthalmol 2021; 99:e160-e163. [PMID: 32588987 DOI: 10.1111/aos.14535] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To analyse the prevalence, incidence and aetiology of paediatric uveitis. METHODS A retrospective, population-based cohort study of Finnish children with uveitis in Northern Ostrobothnia Hospital District in 2008-2017. The data included parameters for age, gender, age at diagnosis, laterality, chronicity, anatomical distribution of the disease, aetiology and systemic association. RESULTS One hundred fifty patients aged <16 years (mean age 6.9 ± 3.9 years) with uveitis were included, out of whom 53% were girls. The first uveitis episode occurred at 1-6 years in 59%, and 62% of them were girls. In the age group of 7-15 years, boys were diagnosed with uveitis more frequently than girls (61% versus 39%, respectively). Seventy percent of the girls were diagnosed with their first uveitis episode at the age of 1-6 years, whereas only 48% of the boys were diagnosed at that age. The prevalence of uveitis increased from 64/100 000 children <16 years in 2008 (95% CI, 47.7-84.2) to 106/100 000 in 2017 (95% CI, 84.6-130.2). The incidence of childhood uveitis in 2008-2017 was 14/100 000 person-years in children <16 years (95% CI, 11.3-16.5). Eighty-seven percent of the cases were non-infectious, 9% were infectious, and 3% had masquerade syndromes. Sixty-one percent of patients had juvenile idiopathic arthritis (JIA). CONCLUSION The prevalence of paediatric uveitis has increased during the last decade in both genders. Uveitis is more frequent in girls, and they were diagnosed at a younger age than boys. Idiopathic cases and JIA accounted for a majority of aetiological features.
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Affiliation(s)
- Mira Siiskonen
- Department of Ophthalmology Oulu University Hospital Oulu Finland
- PEDEGO Research Unit Oulu Finland
- Medical Research Center University of Oulu Oulu Finland
- Division of Operative Care Oulu University Hospital Oulu Finland
| | - Iida Hirn
- PEDEGO Research Unit Oulu Finland
- Medical Research Center University of Oulu Oulu Finland
| | - Roosa Pesälä
- PEDEGO Research Unit Oulu Finland
- Medical Research Center University of Oulu Oulu Finland
| | - Timo Hautala
- Research Unit of Biomedicine University of Oulu Oulu Finland
| | - Pasi Ohtonen
- Medical Research Center University of Oulu Oulu Finland
- Division of Operative Care Oulu University Hospital Oulu Finland
| | - Nina Hautala
- Department of Ophthalmology Oulu University Hospital Oulu Finland
- PEDEGO Research Unit Oulu Finland
- Medical Research Center University of Oulu Oulu Finland
- Division of Operative Care Oulu University Hospital Oulu Finland
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Yalçındağ FN, Güngör SG, Değirmenci MFK, Sarıgül Sezenöz A, Özçakar ZB, Baskın E, Yalçınkaya FF, Atilla H. The Clinical Characteristics of Pediatric Non-Infectious Uveitis in Two Tertiary Referral Centers in Turkey. Ocul Immunol Inflamm 2019; 29:282-289. [PMID: 31687865 DOI: 10.1080/09273948.2019.1674890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose: To report the manifestations, patterns of disease, treatment strategies and outcomes in pediatric patients with noninfectious uveitis.Methods: Demographic information of 76 cases was recorded. Symptoms, anatomic location, laterality, visual acuity (VA), intraocular pressure, associated systemic diseases, therapeutic strategies, side effects, complications were reviewed.Results: Thirty-one patients were diagnosed as uveitis on routine surveillance because of underlying systemic disease. The most common anatomic location was intermediate uveitis (34.2%). Juvenile idiopathic arthritis (JIA) was the most common underlying systemic disease (25%). Glaucoma was the most common complication (7.7%). The patients with refractory uveitis received adalimumab (26.5%), infliximab (4.6%) and tocilizumab (3.1%). The mean first-year VA was between 20/32 and 20/20 in 116/140 eyes.Conclusion: Most pediatric noninfectious uveitis cases have bilateral intermediate uveitis. JIA was the most common systemic association. The first-year VA was good in most eyes which may be due to early use of corticosteroid-sparing agents.
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Affiliation(s)
| | | | | | | | | | - Esra Baskın
- Department of Pediatric Rheumatology, Başkent University, Ankara, Turkey
| | | | - Huban Atilla
- Department of Ophthalmology, Ankara University, Ankara, Turkey
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Herbort CP, Abu El Asrar AM, Takeuchi M, Pavésio CE, Couto C, Hedayatfar A, Maruyama K, Rao X, Silpa-Archa S, Somkijrungroj T. Catching the therapeutic window of opportunity in early initial-onset Vogt-Koyanagi-Harada uveitis can cure the disease. Int Ophthalmol 2018; 39:1419-1425. [PMID: 29948499 DOI: 10.1007/s10792-018-0949-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Vogt-Koyanagi-Harada (VKH) disease is a primary autoimmune granulomatous choroiditis that begins in the choroidal stroma. The aim of this review was to gather a body of evidence for the concept of a window of therapeutic opportunity, defined as a time interval following initial-onset disease during which adequate treatment will substantially modify the disease outcome and possibly even lead to cure, similar to what has been described for rheumatoid arthritis. METHODS We reviewed the literature and consulted leading experts in VKH disease to determine the consensus for the notion of a therapeutic window of opportunity in VKH disease. RESULTS We found a substantial body of evidence in the literature that a therapeutic window of opportunity exists for initial-onset acute uveitis associated with VKH disease. The disease outcome can be substantially improved if dual systemic steroidal and non-steroidal immunosuppressants are given within 2-3 weeks of the onset of initial VKH disease, avoiding evolution to chronic disease and development of "sunset glow fundus." Several studies additionally report series in which the disease could be cured, using such an approach. CONCLUSIONS There is substantial evidence for a therapeutic window of opportunity in initial-onset acute VKH disease. Timely and adequate treatment led to substantial improvement of disease outcome and prevented chronic evolution and "sunset glow fundus," and very early treatment led to the cure after discontinuation of therapy in several series, likely due to the fact that the choroid is the sole origin of inflammation in VKH disease.
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Affiliation(s)
- Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Rue Charles-Monnard 6, 1003, Lausanne, Switzerland. .,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland.
| | - Ahmed M Abu El Asrar
- Department of Ophthalmology and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Masuru Takeuchi
- Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan
| | - Carlos E Pavésio
- National Institute for Health Research, Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust and UCL, Institute of Ophthalmology, London, UK
| | - Cristobal Couto
- Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
| | - Alireza Hedayatfar
- Noor Eye Hospital and Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Kazuichi Maruyama
- Department of Innovative Visual Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Xi Rao
- Department of Ophthalmology, General Police Hospital, University of Chile, Santiago, Chile
| | - Sukhum Silpa-Archa
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Thanapong Somkijrungroj
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Curragh DS, O’Neill M, McAvoy CE, Rooney M, McLoone E. Pediatric Uveitis in a Well-Defined Population: Improved Outcomes with Immunosuppressive Therapy. Ocul Immunol Inflamm 2017; 26:978-985. [DOI: 10.1080/09273948.2017.1305420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- David S. Curragh
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, UK
| | - Marie O’Neill
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, UK
| | - Clara E. McAvoy
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, UK
| | - Madeleine Rooney
- Centre for Experimental Medicine, Queens University of Belfast, Belfast, UK
| | - Eibhlin McLoone
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, UK
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Cunningham ET, Smith JR, Tugal-Tutkun I, Rothova A, Zierhut M. Uveitis in Children and Adolescents. Ocul Immunol Inflamm 2017; 24:365-71. [PMID: 27471956 DOI: 10.1080/09273948.2016.1204777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Emmett T Cunningham
- a Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA.,b The Department of Ophthalmology , Stanford University School of Medicine , Stanford , California , USA.,c The Francis I. Proctor Foundation , UCSF School of Medicine , San Francisco , California , USA
| | - Justine R Smith
- d Eye & Vision Health , Flinders University School of Medicine , Adelaide , South Australia , Australia
| | - Ilknur Tugal-Tutkun
- e Department of Ophthalmology , Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey
| | - Aniki Rothova
- f Department of Ophthalmology ; Erasmus Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Manfred Zierhut
- g Centre for Ophthalmology , University Tuebingen , Tuebingen , Germany
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