1
|
Hsu AY, Kuo HT, Lin CJ, Hsia NY, Kuo SC, Wei CC, Lai CT, Chen HS, Wang YH, Wei JCC, Tsai YY. Cataract Development Among Pediatric Patients With Uveitis. JAMA Netw Open 2024; 7:e2419366. [PMID: 38949811 PMCID: PMC11217876 DOI: 10.1001/jamanetworkopen.2024.19366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/28/2024] [Indexed: 07/02/2024] Open
Abstract
Importance The long-term estimated risk of development of cataracts among pediatric patients with uveitis is not clear. Objective To describe factors associated with the development of cataracts among pediatric patients with uveitis. Design, Setting, and Participants This cohort study used the international TriNetX database to enroll pediatric patients with and without uveitis from January 1, 2002, to December 31, 2022. The nonuveitis cohort consisted of randomly selected control patients matched by age, sex, race and ethnicity, and specific comorbidities. Exposure Diagnosis of uveitis, identified using diagnostic codes. Main Outcomes and Measures The primary outcome was the risk of developing cataracts among the uveitis group compared with the nonuveitis comparison group, with hazard ratios (HRs) and 95% CIs reported. Results A total of 22 687 pediatric patients with uveitis (mean [SD] age, 10.3 [5.6] years; 54.2% male) and 22 687 comparators without uveitis (mean [SD] age, 10.3 [5.6] years; 54.5% male) were enrolled in the study. The risk of cataracts was increased among pediatric patients with uveitis up to a follow-up duration of 20 years (HR, 17.17; 95%CI, 12.90-22.80) from the index date. Subgroup analyses revealed an elevated cataract risk across age groups: 0 to 6 years (HR, 19.09; 95% CI, 10.10-36.00), 7 to 12 years (HR, 27.16; 95% CI, 15.59-47.20), and 13 to 18 years (HR, 13.39; 95% CI, 8.84-20.30); both female sex (HR, 13.76; 95% CI, 9.60-19.71) and male sex (HR, 11.97; 95% CI, 8.47-16.91); and Asian (HR, 13.80; 95% CI, 3.28-58.07), Black or African American (HR, 10.41; 95% CI, 5.60-19.36), and White (HR, 15.82; 95% CI, 11.05-22.60) race. Furthermore, increased cataract risks were also observed among those with and without a history of immunosuppressive agents (with: HR, 26.52 [95% CI, 16.75-41.90]; without: HR, 17.69 [95% CI: 11.39-27.40]), a history of steroid eye drop use (with: HR, 29.51 [95% CI, 14.56-59.70]; without: HR, 16.49 [95% CI, 11.92-22.70]), and a history of intraocular procedures (with: HR, 11.07 [95%CI, 4.42-27.71]; without: HR, 14.49 [95% CI, 10.11-20.70]). Conclusions and Relevance In this cohort study of pediatric patients with uveitis, an elevated risk of cataracts following a uveitis diagnosis was found compared with pediatric patients without uveitis. The findings suggest that pediatric patients with uveitis should be monitored for cataract development.
Collapse
Affiliation(s)
- Alan Y. Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City, Taiwan
| | - Hou-Ting Kuo
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City, Taiwan
- Department of General Medicine, China Medical University Hospital, Taifchung City, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
- Department of Optometry, Asia University, Taichung City, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
- Department of Optometry, Asia University, Taichung City, Taiwan
| | - Shu-Chun Kuo
- Department of Ophthalmology, Chi Mei Medical Center, Tainan City, Taiwan
- Department of Optometry, Chung Hwa University of Medical Technology, Tainan City, Taiwan
| | - Chang-Ching Wei
- School of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Children’s Hospital, China Medical University Hospital, Taichung City, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
- Department of Optometry, Asia University, Taichung City, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd, Fresenius Medical Care, Taichung City, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - James Cheng-Chung Wei
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung City, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung City, Taiwan
- Institute of Integrated Medicine, China Medical University, Taichung City, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
- Department of Optometry, Asia University, Taichung City, Taiwan
| |
Collapse
|
2
|
Albaqami FM, Alotaibi MA, Alrabie WK, Albaqami MM, Alfadli FM, Alobaylan HA, Althbaiti MA, Alosaimi AS, Alharthi F, Althomali TA. The Effects of Cataract Surgery on Children's Vision: A Systematic Review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S67-S71. [PMID: 38595431 PMCID: PMC11000933 DOI: 10.4103/jpbs.jpbs_995_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/10/2023] [Accepted: 10/22/2023] [Indexed: 04/11/2024] Open
Abstract
Background Five-fifths of all incidents of blindness in Saudi Arabia may be attributed to cataracts. Cataracts are the second major cause of blindness, responsible for 35.5% of cases. Therefore, the purpose of the research was to measure the visual acuity improvement after cataract surgery in children. Materials and Methods This systematic review followed PRISMA guidelines for reporting systematic reviews. All procedures followed the recommendations of the Cochrane handbook. Studies of varying study designs, both published and unpublished, are included. Retrospective studies with outcomes of pediatric cataract surgery were identified from various databases. Result After an initial screening, 108 out of 167 items were deemed unsuitable for publication. There were 59 full-text papers assessed for inclusion, and only seven matched the criteria. All the articles included were of a very high standard. Both the duration of therapy and the target population varied widely between the studies. Conclusion The results indicated that the majority of childhood cataracts are hereditary. Primary posterior capsulectomy and anterior vitrectomy combined with cataract extraction and intra-ocular lens implantation is the treatment of choice for pediatric cataracts. It is recommended that surgery be performed in a properly equipped facility staffed by trained, cooperative personnel and that different procedures be used to enhance post-operative follow-up.
Collapse
Affiliation(s)
- Fahad M. Albaqami
- Department of Ophthalmology, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | - Muath A. Alotaibi
- Department of Plastic Surgery, King Faisal Medical Complex, Taif, Saudi Arabia
| | - Waleed K. Alrabie
- Department of Ophthalmology, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Majed M. Albaqami
- General Physician, Critcal Care Department, Ministry of Defence, Taif, Saudi Arabia
| | - Faisal M. Alfadli
- Department of Emergency, King Faisal Medical Complex, Taif, Saudi Arabia
| | - Hamoud A. Alobaylan
- Department of Emergency, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | | | - Ahmed S. Alosaimi
- Department of Emergency, King Faisal Medical Complex, Taif, Saudi Arabia
| | - Faisal Alharthi
- General Physician, Department of Family Medicine, Ministry of Defence, Taif, Saudi Arabia
| | - Talal A. Althomali
- Department of Ophthalmology, College of Medicine, Taif University, Taif, Saudi Arabia
| |
Collapse
|
3
|
Sun N, Wang C, Linghu W, Li X, Zhang X. Demographic and clinical features of pediatric uveitis and scleritis at a tertiary referral center in China. BMC Ophthalmol 2022; 22:174. [PMID: 35436862 PMCID: PMC9017000 DOI: 10.1186/s12886-022-02404-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background To analyse demographic, clinical features, treatment and therapeutic outcomes of pediatric uveitis and scleritis patients. Subjects The clinical records of pediatric uveitis and scleritis cases between January 2012 and December 2020 at a tertiary uveitis service center in Tianjin Medical University Eye Hospital (TMUEH) were reviewed. Results In total, 209 patients (337 eyes) were included, 49.3% were male. The median onset age was 9.0 (IQR, 7.0–12.0) years. Chronic uveitis and scleritis accounted for 86.1%. Panuveitis (29.2%), anterior uveitis(29.2%), and intermediate uveitis (22.0%) were the most common presentations. The most common diagnoses were idiopathic (71.3%), JIA (8.1%), and infectious uveitis (4.8%). At baseline, 40.7% patients received oral corticosteroid therapy; during follow-up, corticosteroids (66.0%), disease-modifying antirheumatic drugs (61.2%), and biologic agents (35.4%) were the mainstay. Posterior synechia (26.1%) and cataracts (25.5%) were the most common complications. In acute cases, the median best corrected visual acuity (BCVA) was 0.99 (IQR, 0.5–1.0) at baseline and 0 (IQR, 0–0) at last follow-up; in chronic cases, the median BCVA improved from 1.09 (IQR, 0.5–2.0) to 0.27 (IQR, 0–0.5), with anterior chamber cell grade significantly declining. Ten eyes underwent cataract surgery during regular follow-up and achieved satisfactory long-term visual outcomes and decreased burden of immunosuppressants. The incidence of steroid-induced ocular hypertension was 41.0%, and children with frequent instillation of eyedrops were at high risk. Conclusions Most cases were of chronic uveitis and scleritis requiring long-term systemic immunosuppressive therapies in pediatric uveitis and scleritis in China. Good management of complications is important for long-term prognosis.
Collapse
Affiliation(s)
- Nan Sun
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Chunxi Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Wenrui Linghu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaomin Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.
| |
Collapse
|
5
|
Karaca U, Usta G. The usability of lamellar scleral autograft in ocular perforation treatment. Int Ophthalmol 2021; 42:377-383. [PMID: 34176032 DOI: 10.1007/s10792-021-01922-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/19/2021] [Indexed: 11/27/2022]
Abstract
IMPORTANCE Open globe injury is a frequent and preventable healthcare problem with an annual incidence of 3.5/100,000 worldwide. Management and treatment methods aim to ensure globe integrity. Unfortunately, it is not possible to achieve globe integrity in some of the cases, and these can result in poor visual outcomes. PURPOSE To evaluate the usability of lamellar scleral graft in the repair of ocular perforations. METHODS This was a retrospective review of 11 patients who underwent lamellar scleral graft surgery for ocular perforation between June 2015 and June 2020. Due to the failure of the repairs when other techniques were used, the perforation zones were sealed with lamellar scleral autografts. The primary measures of the outcomes were globe integrity, postoperative best corrected visual acuity, and intraocular pressure (IOP). Visual acuity was determined using the Snellen eye chart, and IOP was measured using the automated pneumatic tonometry during standard examination. RESULTS The participants enrolled in this study included 11 patients who underwent lamellar scleral patch graft between 2015 and 2020. The mean age of the patients was 58.81 ± 16.6 years (range, 16-77), and the mean follow-up period was 12.5 ± 3.8 months (range, 8-20). During the surgery, the perforation zone was treated and no leakage was observed. IOP significantly increased, and visual acuity improved in almost all eyes. The factors that made it necessary to use scleral grafts in patients were star-shaped wounds, delayed presentation, lost corneal / scleral tissue. CONCLUSION Lamellar scleral graft is a method that can be used in the treatment of defective ocular perforation with acceptable complications and provides adequate functional and structural stability. Scleral patch grafting can be considered as an alternative option for surgeons treating a variety of ocular conditions that cause tectonic imbalance or poor cosmesis.
Collapse
Affiliation(s)
- Umut Karaca
- Department of Ophthalmology, Faculty of Medicine, Isparta Suleyman Demirel University, Isparta, Turkey.
| | - Gulsah Usta
- Department of Ophthalmology, Faculty of Medicine, Isparta Suleyman Demirel University, Isparta, Turkey
| |
Collapse
|
6
|
Cataract Surgery with or without Intraocular Lens Implantation in Pediatric Uveitis: A Systematic Review with Meta-Analyses. J Ophthalmol 2021; 2021:5481609. [PMID: 34221492 PMCID: PMC8213487 DOI: 10.1155/2021/5481609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/05/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose To systematically review the results of comparative studies of modern cataract surgery in pediatric uveitis with or without intraocular lens (IOL) implantation and to perform comparative meta-analyses to compare visual acuity outcomes and complication rates. Methods On 12 November 2020, we systematically searched the Cochrane Central, PubMed/MEDLINE, EMBASE, ClinicalTrials.gov, and all affiliated databases of the Web of Science. Two authors independently reviewed studies and extracted data. Studies were reviewed qualitatively in text and quantitatively with meta-analyses. Outcome measures were preoperative and postoperative best-corrected visual acuity (BCVA), inflammation control, and rates of postoperative complications. Results Ten studies of 288 eyes were eligible for review of which the majority were eyes with juvenile idiopathic arthritis-associated uveitis. Summary estimates revealed that the BCVA was better in pseudophakic eyes vs. aphakic eyes (1-year postoperative: −0.23 logMAR, 95% CI: −0.43 to −0.03 logMAR, P=0.027; 5-year postoperative: −0.35 logMAR, 95% CI: −0.51 to −0.18 logMAR, P=0.000036). Pseudophakic eyes had more visual axis opacification (OR 6.76, 95% CI: 2.73 to 16.8, P=0.000036) and less hypotony (OR 0.19, 95% CI: 0.04 to 0.95, P=0.044). Conclusions In modern era cataract surgery on eyes with pediatric uveitis with IOL implantation leads to satisfactory and superior visual outcomes and no differences in complication rates apart from an increased prevalence of visual axis opacification and a decreased prevalence of hypotony when compared to aphakia. However, limitations of the retrospective design and the presence of selection bias necessitate a careful interpretation.
Collapse
|
7
|
Cataract Surgery with Intraocular Lens Implantation in Juvenile Idiopathic Arthritis-Associated Uveitis: Outcomes in the Era of Biological Therapy. J Clin Med 2021; 10:jcm10112437. [PMID: 34072679 PMCID: PMC8198606 DOI: 10.3390/jcm10112437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/21/2021] [Accepted: 05/29/2021] [Indexed: 12/24/2022] Open
Abstract
This study compared the outcomes of cataract surgery with intraocular lens (IOL) implantation in patients with juvenile idiopathic arthritis (JIA)-associated chronic anterior uveitis treated with antimetabolite drugs and systemic corticosteroids (Non-Biological Group) versus patients treated with antimetabolites and biological drugs (Biological Group). A cohort of patients with cataract in JIA-associated uveitis undergoing phacoemulsification with IOL implantation was retrospectively evaluated. The main outcome was a change in corrected distance visual acuity (CDVA) in the two groups. Ocular and systemic complications were also recorded. The data were collected preoperatively and at 1, 12, and 48 months after surgery. Thirty-two eyes of 24 children were included: 10 eyes in the Non-Biological Group and 22 eyes in the Biological Group. The mean CDVA improved from 1.19 ± 0.72 logMAR preoperatively to 0.98 ± 0.97 logMAR at 48 months (p = 0.45) in the Non-Biological Group and from 1.55 ± 0.91 logMAR preoperatively to 0.57 ± 0.83 logMAR at 48 months (p = 0.001) in the Biological Group. The postoperative complications, including synechiae, cyclitic membrane, IOL explantation, glaucoma, and macular edema, were not statistically different between the two groups. An immunosuppressive treatment with biological drugs can improve the visual outcome after cataract surgery in patients with JIA-associated uveitis, but it does not significantly reduce postoperative ocular complications.
Collapse
|