Overview and recent developments in the medical management of paediatric uveitis.

INTRODUCTION: Although rarer than its adult counterpart, non-infectious uveitis remains a significant cause of ocular morbidity in children. Owing to the chronicity of the disorder and when refractory to first-line treatment, namely corticosteroids, systemic immunosuppressive treatment may be required to control the disease. AREAS COVERED: Following a literature search using the keywords 'paediatric uveitis', 'juvenile idiopathic arthritis-associated uveitis', 'immunosuppression' and 'treatment', we reviewed the range and effectiveness of treatments employed in the management of non-infectious, paediatric uveitis. EXPERT OPINION: Corticosteroids (topical, periocular, intraocular or systemic) remain the initial drug of choice in ameliorating the signs and symptoms of non-infectious paediatric uveitis. Failure to control the disease and/or failure to reduce the oral dose of prednisolone at least 0.15 mg/kg within 4 weeks often requires additional immunosuppressant therapy. Methotrexate and azathioprine have shown to be effective in the management of juvenile idiopathic arthritis (JIA)-associated uveitis with the former considered the first-line corticosteroid-sparing agent. Biologic therapies are increasingly used earlier in the disease with investigators in the UK currently recruiting patients for the SYCAMORE trial evaluating the efficacy of methotrexate and adalimumab vs methotrexate alone for the treatment for JIA-associated uveitis. Until further randomised controlled trials are conducted, the use of other biologic agents should only be used with an appreciation that there are potentially unknown side-effects and that there is not a full knowledge of their efficacy.

Optimising assessment intervals improves visual outcomes in ranibizumab-treated age-related neovascular degeneration: using the stability phase as a benchmark.

BACKGROUND: To observe visual acuity change in the stability phase when follow-up intervals are decreased in ranibizumab-treated neovascular age-related macular degeneration (nvAMD). METHODS: Selection of patients was based on a review of a cohort of 189 eyes of 154 patients with nvAMD treated with intravitreal ranibizumab in routine clinical practice. Patients were transferred from a base hospital with a 8-week follow-up interval to a community eye clinic, enabling a new follow-up interval of 4 weeks. Staff, assessment, and treatment protocols were equivalent in the two centres. Patients were included when they were in the stability phase of treatment defined 1 month after having completed their three initiation treatments with ranibizumab. Each patient was required to have attended at least a further 12 visits; this means a follow-up time for a year or longer, consisting of six visits at the base hospital followed by six visits at the new eye clinic. The best-corrected visual acuity (BCVA), follow-up intervals and injection numbers were collected. RESULTS: Seventy-two eyes of 62 patients were included. The mean follow-up interval for the six visits in the base hospital was 56.81 days, and in the new eye centre 31.81 days. The BCVA loss in the base hospital was -1.13 letters, compared to a gain of +4.61 letters in the community eye clinic over the six visits. The number of ranibizumab injections was 3.67 in the base hospital, compared with 3.91 in the other centre over the respective periods. CONCLUSION: Visual acuity improves and severe visual loss decreases when follow-up intervals reduce from approximately 8 weeks to 4 weeks. Furthermore, using the stability phase to evaluate the outcome and effectiveness of our treatments for age-related macular degeneration appeared to be an efficient tool.