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Br J Ophthalmol. 2019 May 2. pii: bjophthalmol-2018-313789. doi: 10.1136/bjophthalmol-2018-313789. [Epub ahead of print]

Areas of agreement in the management of childhood non-infectious chronic anterior uveitis in the UK.

Author information

1
Lifecourse Epidemiology and Biostatistics Section, Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health University College London, London, UK a.solebo@ucl.ac.uk.
2
NIHR Biomedical Research Centre at Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London, UK.
3
Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.
4
National Institute for Health Research (NIHR) Biomedical Research Centre at Great Ormond Street Hospital and Institute of Child Heath, UniversityCollege London, London, UK.
5
Lifecourse Epidemiology and Biostatistics Section, Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health University College London, London, UK.
6
Ophthalmology Department, University of Bristol, Bristol, UK.
7
Bristol Medical School Translational Health Sciences, University of Bristol, Bristol, UK.
8
Manchester Royal Eye Hospital, Manchester University Hospitals NHS Trust, Manchester, UK.

Abstract

BACKGROUND/AIMS:

There is a paucity of high-level evidence to support the management of childhood uveitis, particularly for those children without juvenile idiopathic arthritis uveitis (JIA). We undertook a modified Delphi consensus exercise to identify agreement in the management of chronic anterior uveitis (CAU), the most common manifestation of childhood disease.

METHODS:

A four-round, two-panel process was undertaken between June and December 2017. Paediatric uveitis specialists identified through multiple sources, including a multicentre network (the Paediatric Ocular Inflammation Group), were invited to participate. They were asked whether they agreed with items derived from existing guidelines on the management of JIA-U when extrapolated to the population of all children with CAU. Consensus was defined as agreement greater than or equal to 75% of respondents.

RESULTS:

26 of the 38 (68%) invited specialists participated with the exercise, and response rates were 100% for rounds one to three, and 92% for round four. Consensus was reached on 23 of the 44 items. Items for which consensus was not reached included management at presentation, use of systemic and periocular steroids for children with severe disease and the role of conventional steroid sparing immunosuppressants beyond methotrexate.

CONCLUSION:

The areas of management uncertainty at the level of the group, as indicated by absence of consensus, reflect the areas where the evidence base is particularly poor. Our findings identify the key areas for the future research needed to ensure better outcomes for this blinding childhood ocular inflammatory disorders.

KEYWORDS:

child; delphi technique; disease management; uveitis

Conflict of interest statement

Competing interests: AV Ramanan is Co-Chief Investigator of the Sycamore study which is funded by NIHR and ARUK, and has received Honoraria/Consultancy and speaker fees from Abbvie, Lilly, UCB, SOBI and Novartis. C Guly and JA have received fees from AbbVie (as speaker and advisory board member).

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