Challenges and management of childhood noninfectious chronic uveitis

ABSTRACT

Introduction

Childhood uveitis is a sight-threatening condition, because if not properly recognized and treated can lead to several ocular complications and blindness. It represents a real challenge not only from an etiologic/diagnostic point of view, but also for management and therapy

Areas covered

In this review we will discuss the main etiologies, the diagnostic approach, risk factors associated to childhood noninfectious uveitis (cNIU), and the difficulties in eye examination in childhood. Moreover, we will discuss the treatment of cNIU in terms of therapeutic choice, timing of initiation, and withdrawal.

Expert opinion

Identification of specific diagnosis is mandatory to prevent severe complications, thus a thorough differential diagnosis is essential. Pediatric eye examination may be extremely challenging due to the scarce collaboration, but novel techniques and biomarkers will help in identifying low grade of inflammation, eventually modifying long-term outcomes. Once identified the appropriate diagnosis, recognition of children who may benefit of a systemic treatment is crucial. What, When, and how long are the key questions to address in this field. Current evidence and future results of ongoing clinical trials will help in driving treatment. A proper ocular screening, not only in the context of systemic disease, should be discussed by experts.

KEYWORDS:

• Adalimumab
• Anti-TNF
• AS-OCT
• children
• JAK-inhibitors
• JIA
• Tocilizumab
• Uveitis

Article highlights

• Childhood uveitis is a sight-threatening condition that needs a timely and specific treatment

• Close collaboration among ophthalmologist, rheumatologist and infectivologist is the cornerstone for the management of pediatric uveitis

• A thorough differential diagnosis is crucial in early identifying the specific and appropriate treatment

• An ophthalmic screening is necessary not only in children with Juvenile Idiopathic Arthritis, but also in the general pediatric population

• Ocular examination in patients with uveitis needs to include slit lamp examination along with the posterior segment examination.

• novel techniques to properly measure the grade of inflammation results helpful in specific s

• Treatment of childhood noninfectious uveitis is challenging in terms of timing, drug choice and treatment duration

• Anti-TNF and methotrexate represent the first choice of systemic therapy

• When an anti-TNF fails in achieving ocular inflammation control other drugs are available, but there is no accordance about the next steps

• Future results of the ongoing clinical trials will help in driving the more appropriate therapeutic choice.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.