Related Experiment Video
Updated: Sep 20, 2025
Primed Mycobacterial Uveitis PMU as a Model for Post-Infectious Uveitis
Published on: December 17, 2021
Safety of Intravenous Methylprednisolone in Refractory and Severe Pediatric Uveitis
Hashem H Ghoraba1, Wataru Matsumiya1,2, Hassan Khojasteh1
1Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
Insights
Intravenous high-dose pulse methylprednisolone succinate (IVHDM) shows potential for treating severe pediatric uveitis. Adverse events were linked to treatment duration and concurrent therapies, suggesting careful monitoring is crucial.
Area of Science:
- Ophthalmology
- Pediatric Rheumatology
- Clinical Pharmacology
Background:
- Pediatric uveitis is a severe ocular inflammatory condition requiring effective treatment.
- Refractory or severe cases often necessitate aggressive therapeutic strategies.
- Intravenous high-dose pulse methylprednisolone succinate (IVHDM) is a potential treatment option.
Purpose of the Study:
- To evaluate the safety and efficacy of IVHDM in managing severe or refractory non-infectious pediatric uveitis.
- To identify adverse events associated with IVHDM treatment in this population.
Main Methods:
- Retrospective review of pediatric patients (≤16 years) treated with IVHDM (≥500 mg/day for ≥3 months).
- Data collected on patient demographics, treatment duration, dosage, concurrent therapies, and adverse events.
- Statistical analysis to correlate adverse events with treatment parameters.
Main Results:
- 14 pediatric patients met inclusion criteria, treated for an average of 14.2 months.
- Three major adverse events (bradycardia, compression fracture, adrenal insufficiency) occurred in two patients.
- Adverse events correlated with treatment duration and cumulative dose; weight gain linked to oral steroids.
Conclusions:
- IVHDM may be a viable treatment for aggressive pediatric uveitis.
- Adverse events observed could be influenced by concurrent immunomodulatory therapy or the underlying disease.
Purpose:
To evaluate the safety of intravenous high-dose pulse methylprednisolone succinate (IVHDM) in the management of severe or refractory non-infectious pediatric uveitis.
Methods:
We reviewed all uveitis patients who were ≤16 years of age and who received IVHDM with a dose of ≥500 mg per day (1-3 days a month) for at least 3 months during their management at a tertiary care eye hospital.
Results:
Twenty pediatric patients with severe or refractory uveitis who received IVHDM were identified. Six patients received IVHDM either once, as a preoperative medication, or at a lower dose than 500 mg, and were excluded. The remaining 14 patients received IVHDM for at least 4 months. Age (mean±SD) was 11.9±2.4 years and 50% were female. Duration of treatment was 14.2±7.5 months. Thirteen patients received IVHDM in combination with other immunomodulatory therapy (IMT). Except for two outliers, IVHDM was given at a dose of 8-25 mg/kg per infusion. Three major adverse events (AEs) occurred in two patients: a single episode of bradycardia, compression fracture following minor trauma and adrenal insufficiency. The number of AEs (major and minor) strongly correlated with duration of treatment (p=0.004) and moderately correlated with the cumulative dose/weight (p=0.051). Weight gain was associated with the use of concomitant oral steroids and not with duration of treatment or cumulative dose.
Conclusion:
IVHDM may be a valid therapeutic option for aggressive/refractory pediatric uveitis. The reported AEs in this series can also be attributed to the concurrent IMT or the underlying disease itself.
Related Concept Videos
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids