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Molimard J, Pajot C, Olle P, Belot A, Quartier P, Uettwiller F, Couret C, Coste V, Costet C, Bodaghi B, Dureau P, Bailhache M, Pillet P. Immunomodulatory treatment and surgical management of idiopathic uveitis and juvenile idiopathic arthritis-associated uveitis in children: a French survey practice. Pediatr Rheumatol Online J 2021; 19:139. [PMID: 34479590 PMCID: PMC8414774 DOI: 10.1186/s12969-021-00626-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgeries for idiopathic uveitis and juvenile idiopathic arthritis-associated uveitis in children are complex because of the high risk of inflammatory postoperative complications. There is no consensus about treatment adaptation during the perioperative period. The objectives of this study are to report the therapeutic changes made in France and to determine whether maintaining or stopping immunosuppressive therapies is associated with an increased risk of surgical site infection or an increased risk of uveitis or arthritis flare-up. METHODS We conducted a retrospective cohort study between January 1, 2006 and December 31, 2018 in six large University Hospitals in France. Inclusion criteria were chronic idiopathic uveitis or chronic uveitis associated with juvenile idiopathic arthritis under immunosuppressive therapies at the time of the surgical procedure, operated before the age of 16. Data on perioperative treatments, inflammatory relapses and post-operative infections were collected. RESULTS A total of 76 surgeries (42% cataract surgeries, 30% glaucoma surgeries and 16% posterior capsule opacification surgeries) were performed on 37 children. Adaptation protocols were different in the six hospitals. Immunosuppressive therapies were discontinued in five cases (7%) before surgery. All the children in the discontinuation group had an inflammatory relapse within 3 months after surgery compared to only 25% in the other group. There were no postoperative infections. CONCLUSIONS The results of this study show varying practices between centres. The benefit-risk balance seems to favour maintaining immunosuppressive therapies during surgery. Further studies are needed to determine the optimal perioperative treatments required to limit post-operative inflammatory relapses.
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Affiliation(s)
- Julie Molimard
- Pediatric diseases and Rheumatology, CHU Bordeaux, Bordeaux, France.
| | - Christine Pajot
- grid.411175.70000 0001 1457 2980Department of Pediatric Nephrology, Internal Medicine and Hypertension, CHU Toulouse, Toulouse, France
| | - Priscille Olle
- grid.414282.90000 0004 0639 4960Department of Ophtalmology, Hôpital Purpan, CHU Toulouse, Toulouse, France
| | - Alexandre Belot
- grid.413852.90000 0001 2163 3825Department of Pediatric Nephrology, Rheumatology, Dermatology, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Femme Mère Enfant, CHU Lyon, Lyon, France
| | - Pierre Quartier
- grid.412134.10000 0004 0593 9113Paediatric Hematology-Immunology and Rheumatology Department, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Florence Uettwiller
- grid.411167.40000 0004 1765 1600Department of Allergology and Clinical Immunology, Hôpital Clocheville, CHRU de Tours, Tours, France
| | - Chloé Couret
- grid.277151.70000 0004 0472 0371Department of Ophtalmology, Hôtel-Dieu, CHU Nantes, Nantes, France
| | - Valentine Coste
- grid.42399.350000 0004 0593 7118Department of Ophtalmology, CHU Bordeaux, Bordeaux, France
| | - Camille Costet
- grid.42399.350000 0004 0593 7118Department of Ophtalmology, CHU Bordeaux, Bordeaux, France
| | - Bahram Bodaghi
- grid.411439.a0000 0001 2150 9058Department of Ophtalmology, Hopital Pitié-Salpêtrière, APHP, Paris, France
| | - Pascal Dureau
- grid.417888.a0000 0001 2177 525XPediatric Ophthalmology Department, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Marion Bailhache
- grid.42399.350000 0004 0593 7118Department of Pediatric emergencies, CHU Bordeaux, Bordeaux, France
| | - Pascal Pillet
- grid.42399.350000 0004 0593 7118Pediatric diseases and Rheumatology, CHU Bordeaux, Bordeaux, France
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