title: Immunosuppressants used in a steroid-sparing strategy for childhood uveitis.
abstract: To review, with respect to etiology, the efficacy and complications of different immunosuppressants used in a steroid-sparing strategy for children with uveitis.
  
  
  
  Forty children with uveitis were observed during a 5-year period, from 1997 to 2002. After complete ocular and physical assessment, routine and specific laboratory investigations were conducted along with radiologic examination. All cases underwent local therapy. Systemic corticosteroids were necessary in 75% of cases. Pediatric staff determined the need for initial association or sequential relay with immunosuppressants, depending on the severity of the uveitis. A steroid-sparing strategy was developed.
  
  
  
  The average age was 6.5 years (range, 3 months to 14 years), with a male-to-female ratio of 23 to 17. Uveitis was anterior in 55% of cases, intermediate in 2.5%, posterior in 42.5%, and bilateral in 62.5%. A positive etiology was found in 47.5% of cases, and articular symptoms were present in 25%. Overall, the improvement in visual acuity was 62.2%. Where corticotherapy was associated with azathioprine, a 61% improvement was achieved. Corticosteroid therapy associated with mycophenolate mofetil resulted in a 94% improvement. No complications were present in 42.5% of cases. Ocular complications were present in 57.5% of cases and systemic complications were present in 12.5% of cases, none being directly related to the use of steroids.
  
  
  
  The association of systemic corticotherapy and immunosuppressants in pediatric relapsing or steroid-dependent uveitis allows good recovery of visual acuity, fewer complications, and a minimization of side effects, especially those related to systemic corticosteroids. It requires close collaboration between the ophthalmologist and a fully involved pediatrician.
authors.affiliation: Strasbourg University Eye Hospital, BP 426 1 place de l'Hôpital, 67091 Strasbourg, France.
authors.forename: Claude Speeg
authors.initials: CS
authors.lastname: Schatz
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Uzel
authors.forename: Laurent
authors.initials: L
authors.lastname: Leininger
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Danner
authors.forename: Joëlle
authors.initials: J
authors.lastname: Terzic
authors.forename: Michel
authors.initials: M
authors.lastname: Fischbach
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014606:Uveitis, Anterior / Q000188:drug therapy* / Q000453:epidemiology; D015867:Uveitis, Intermediate / Q000188:drug therapy* / Q000453:epidemiology; D015866:Uveitis, Posterior / Q000188:drug therapy* / Q000453:epidemiology; D014792:Visual Acuity
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents