042. The experience in children presenting with Uveitis in the city of Abu-Dhabi

Abstract

Background: Uveitis in children can lead to blindness or other serious complications if there is delay or inadequate treatment Aims: Uveitis in children can lead to blindness or other serious complications if there is delay or inadequate treatment Methods: Cases with the diagnosis of uveitis identified through electronic Medical Record from 1/1/2011 to 31/6/2017 using International Classification of Disease version 10 (ICD 10 code) of H20.0, H20.011, H20.012, H20.013, H20.041, H20.042, H20.043, H20.10, H20.11, H20.12, H20.13, 47307, 809078, 809537, 809532, 809534, 84478, 84479, 40591, 845023, 845024, 845025, 809533, 16801, 16796, 1630604, 1629868 and 1623122. Retrospective review and descriptive analysis performed by SPSS IBM, USA Results: 52 patients identified with the diagnosis of Uveitis. Mean age at diagnosis of 9.66 yrs. Equal male to female ratio. Mean duration from onset to diagnosis of 77 days. 60% of patients seen by Pediatric Rheumatologist (PR). The average duration from diagnosis to the first appointment by (PR) is 152 days. Rheumatic condition was the primary diagnosis in 19 patients (11 had Juvenile Idiopathic Arthritis, 3 sarcoidosis, 2 Behcet's disease, 1 Tubulointerstitial Nephritis and Uveitis Syndrome (TINU), 1 Vogt Koyanagi Harada syndrome uveitis and 1 Multiple-sclerosis associated uveitis). Non-rheumatic conditions in 28 (15 traumatic, 10 idiopathic, 2 tuberculosis, 1 Seckel Syndrome). 44% patients had one eye affected, 56% patients had both eyes affected. 67% patients diagnosed as anterior uveitis, 17% panuveitis, 2% Intermediate Uveitis and 2% posterior uveitis. 44% patients presented with red eye, followed by 34% with blurred vision, 30% with eye pain, 14% with photophobia and 12% with itching and foreign body sensation. For investigation: ANA +ve in 3 patients and -ve in 16 patients. HLA status: B27 was Negative in 12 patients, B51 was negative in 2 patients and positive in 2 patients. For treatment: Topical steroid (96%), methotrexate (44%), systemic steroid (40%), Adalimumab (22%), Mycophenolate mofetil (8%), Etanercept (6%), Tocilizumab (5.7%), Infliximab (4%) and Abatacept (3.8%). 27% needed surgery. 33% developed cataract and 23% had glaucoma. 15 patients had partial loss of vision (30%) and 2 patients (4%) had complete blindness. One patient had methotrexate related liver fibrosis (No Rheumatology Input). Our data showed 62% of patients lost to follow up and 52% had poor compliance. 17% patients had a relapse and 29% had no relapse. Conclusions: Lengthy duration from onset of Uveitis to first appointment with PR (average of 193 days with range of 1 day to 3 years). Some patients on methotrexate or biologics did not get to see PR. Outcome can be improved by managing patients with Uveitis as joint care between Ophthalmology and PR especially patients who are on disease modified drugs.