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Santos Oliveira J, Catarino S, Magalhães A, Rocha G, Santos Silva R. The Red Reflex Test and Leukocoria in Childhood. ACTA MEDICA PORT 2024. [PMID: 39074051 DOI: 10.20344/amp.21367] [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: 02/13/2024] [Accepted: 05/20/2024] [Indexed: 07/31/2024]
Abstract
The red reflex test, performed using a direct ophthalmoscope, serves as a critical diagnostic tool in identifying various ocular conditions. These conditions encompass retinal anomalies (such as retinoblastoma, Coats disease, retinopathy of prematurity, familial exudative vitreoretinopathy, myelinated nerve fibers, ocular toxocariasis, ocular toxoplasmosis, retinochoroidal coloboma, astrocytic, and combined hamartoma), vitreous abnormalities (including persistent fetal vasculature), lens issues (like cataract), anterior chamber and corneal conditions (comprising dysgenesis of the anterior segment, congenital glaucoma, birth trauma), and tear film disturbances. During this examination, the presence of leukocoria, characterized by a white pupillary reflex, can suggest the presence of underlying conditions. Any suspicion of an abnormal red reflex test warrants immediate evaluation by a qualified ophthalmologist. This article primarily underscores the paramount importance of the red reflex examination, not only to identify potential sight-threateningbut also life-threatening conditions. It delves into the most common causes of leukocoria in childhood and offers insights into a comprehensive diagnostic approach. The target audience for this article includes pediatricians, primary care clinicians, and ophthalmologists, all of whom play a pivotal role in the early detection and intervention of these critical eye disorders.
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Affiliation(s)
| | - Sara Catarino
- Pediatrics Department. Unidade Local de Saúde de São João. Porto. Portugal
| | - Augusto Magalhães
- Department of Ophthalmology & Reference Centre of Inherited Metabolic Diseases at the Pediatrics Department. Unidade Local de Saúde de São João. Porto. Portugal
| | - Gustavo Rocha
- Department of Neonatology. Unidade Local de Saúde de São João. Porto. Portugal
| | - Renato Santos Silva
- Department of Ophthalmology. Unidade Local de Saúde de São João. Porto.; Department of Surgery and Physiology. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
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Mooss VS, Babu K. Clinical profile and treatment outcomes in pediatric uveitis - A series from South India. Indian J Ophthalmol 2024; 72:S584-S591. [PMID: 38317316 DOI: 10.4103/ijo.ijo_3131_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/07/2023] [Indexed: 02/07/2024] Open
Abstract
PURPOSE The purpose of the study was to look at the clinical spectrum, treatment options, and visual outcomes in a large cohort of pediatric uveitis from a tertiary eye care center in South India. METHODS This is a retrospective study carried out at a tertiary eye center in South India. Cases of pediatric uveitis between January 2012 and June 2022 were retrieved from the hospital's medical database. Uveitis was classified according to the Standardization of Uveitis Nomenclature criteria. Demographic details, clinical presentation, complications, medical and surgical management, and visual outcome were evaluated. RESULTS Two hundred and six eyes of 132 cases were included, with a median age of 12 years. The male to female ratio was 1:1. Bilaterality was seen in 63.1% of cases. The mean duration of uveitis was 11.5 ± 18.5 months, and the mean follow-up period was 20.5 ± 25.1 months. Noninfectious uveitis was seen in 70.45% cases. Most common etiology in the noninfectious group was idiopathic (27.3%), while in the infectious group, it was tuberculosis (TB; 14.4%). Immunomodulators were used in 43.9% and biologics in 10.9% of cases. Most common complications were cataract (25.24%) and posterior synechiae (21.35%). Surgical procedures were done in 12.62%. The mean visual acuity was 0.81 ± 1.14 log of minimum angle of resolution (logMAR) at presentation and 0.49 ± 0.87 logMAR at the end of the study ( P = 0.002). CONCLUSION Pediatric uveitis poses a challenge in comparison to adult uveitis. Our study highlights the need for early diagnosis and aggressive management to prevent sequelae. Multidisciplinary approach is a key in improving the overall visual prognosis.
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Affiliation(s)
- Vidya S Mooss
- Department of Uvea and Ocular Inflammation, Prabha Eye Clinic and Research Centre and Vittala International Institute of Ophthalmology, Bengaluru, Karnataka, India
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Abdelmageed NH, Adi A, Abo El-Khair S, Shahin M, Mosa DM, Sabry D, El Nokrashy A. Demographic and Clinical Profile of Pediatric Uveitis in Delta Region, Egypt. Ocul Immunol Inflamm 2024:1-9. [PMID: 38527189 DOI: 10.1080/09273948.2024.2328789] [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: 02/14/2024] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Pediatric uveitis poses unique challenges, characterized by difficulties in performing comprehensive examinations, potential delays in diagnosis, and a heightened risk of ocular complications. This study evaluate the etiologic and clinical characteristics of uveitis in children presenting to the Mansoura Ophthalmic Center, Mansoura, Egypt. METHODS A cross-sectional observational study was undertaken involving children diagnosed with uveitis attending the uveitis outpatient clinic at Mansoura University Ophthalmic Center. Comprehensive clinical evaluations were carried out, including detailed history taking and exhaustive ophthalmological examinations. Whenever deemed necessary, Spectral Domain Optical Coherence Tomography (OCT) and Fluorescein Fundus Angiography (FFA) were utilized to secure retinal images. An extensive systemic evaluation was also conducted to discern the diverse causes of uveitis among the participants. RESULTS The cohort comprised 63 children, impacting 97 eyes. Bilateral involvement was seen in 54% of cases, with a male predominance of 58.7%. The predominant etiologies of uveitis were presumed trematode-induced (36.7%), Juvenile Idiopathic Arthritis (JIA) accounting for 28.6%, and in 12.7% of cases, the cause remained undetermined. Anterior uveitis emerged as the primary presentation in 79.4% of cases. Regarding visual loss, cataract was the leading cause at 56.4%, followed by vitritis at 38.4%, and macular edema at 20.5%. CONCLUSION Anterior uveitis was the most frequent presentation in our pediatric cohort. Despite the challenges, the majority of children with uveitis exhibited no significant visual impairment, with most causes of visual loss being reversible.
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Affiliation(s)
| | - Anas Adi
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Samy Abo El-Khair
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Maha Shahin
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Doaa Mosad Mosa
- Department of Rheumatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Dalia Sabry
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Amgad El Nokrashy
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Nguyen AT, Koné-Paut I, Dusser P. Diagnosis and Management of Non-Infectious Uveitis in Pediatric Patients. Paediatr Drugs 2024; 26:31-47. [PMID: 37792254 DOI: 10.1007/s40272-023-00596-5] [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] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
Uveitis in children accounts for 5-10% of all cases. The causes vary considerably. Classically, uveitis is distinguished according to its infectious or inflammatory origin and whether it is part of a systemic disease or represents an isolated ocular disease. It is important to highlight the specificity of certain etiologies among children such as juvenile idiopathic arthritis. The development of visual function can potentially be hindered by amblyopia (children aged < 7 years), in addition to the usual complications (synechiae, macular edema) seen in adult patients. Moreover, the presentation of uveitis in children is often "silent" with few warning signs and few functional complaints from young children, which frequently leads to a substantial diagnostic delay. The diagnostic approach is guided by the presentation of the uveitis, which can be characterized by its location, and corresponds to the initial and main site of intraocular inflammation; its presentation, whether acute or chronic, granulomatous or not; and the response to treatment. Pediatricians have an important role to play and must be aware of the various presentations and etiologies of uveitis in children. Juvenile idiopathic arthritis is the most common etiology of pediatric non-infectious uveitis, but other causes must be recognized. Promptly initiated treatment before complications arise requires early diagnosis, recognition, and treatment. Any dependence on prolonged local corticosteroid therapy justifies discussing the introduction of a corticosteroid-sparing treatment considering the risk to develop corticoid-induced glaucoma and cataracts. Systemic corticosteroid therapy can be required for urgent control of inflammation in the case of severe uveitis. Long-lasting immunosuppressive treatment and biotherapies are most often prescribed at the same time to reinforce treatment efficacy and to prevent relapse and corticosteroid dependency. We review the different causes of uveitis, excluding infection, and the diagnostic and therapeutic management aimed at limiting the risk of irreversible sequelae.
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Affiliation(s)
- Ai Tien Nguyen
- Department of Pediatric Rheumatology, CeReMAIA, CHU Bicêtre, Assistance Publique-Hôpitaux de Paris, Université de Paris Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France.
| | - Isabelle Koné-Paut
- Department of Pediatric Rheumatology, CeReMAIA, CHU Bicêtre, Assistance Publique-Hôpitaux de Paris, Université de Paris Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - Perrine Dusser
- Department of Pediatric Rheumatology, CeReMAIA, CHU Bicêtre, Assistance Publique-Hôpitaux de Paris, Université de Paris Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
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Khazaei S, Bakhtiari E, Ansari Astaneh MR, Hosseini SM. Epidemiology and Clinical Course of Pediatric Uveitis in a Tertiary Referral Center in Northeastern Iran. Ocul Immunol Inflamm 2023; 31:2024-2031. [PMID: 37713536 DOI: 10.1080/09273948.2023.2249985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE To describe the distribution, clinical findings, treatment, complications, and visual outcomes of pediatric uveitis at a tertiary referral ophthalmic center. METHODS The medical records of all patients ≤18 years diagnosed with and managed as uveitis from August 2016 to August 2021 were reviewed retrospectively. RESULTS Of the 97 patients, 52.6% were female, and the mean age at the onset was 10.5 ± 4.6 years (6 months to 18 years). Uveitis cases were predominantly anterior (33 [34%]), chronic (59 [60.8%]), bilateral (63 [64.9%]), and non-infectious (80 [82.5%]). A total of 36.1% (35 patients) of cases were idiopathic, and the most frequent systemic associations were juvenile idiopathic arthritis (JIA), 16 [16.5%]) and Behcet's disease (15 [15.5%]). Most patients (74 [76.3%]) experienced ocular complications, including vasculitis (29 [29.9%]), posterior synechiae (23 [23.7%]), and cataracts (22 [22.7%]). Patients with uveitis of all anatomic locations experienced an improvement in best-corrected visual acuity during the follow-up period (p < 0.01). CONCLUSION The most prevalent systemic associations were JIA and Behcet's disease. Ocular Behcet is a common etiology of pediatric uveitis in northeastern Iran. A timely and appropriate treatment could result in satisfactory visual outcomes.
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Affiliation(s)
- Sahel Khazaei
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Bakhtiari
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Wan W, Chen Z, Xun Y, Yi K, Zhu Y, Pu Y, Su G, Zhou C, Wang Y, Yang P. Comprehensive evaluation of functional vision, quality of life, and cognitive ability in pediatric uveitis. BMC Ophthalmol 2023; 23:381. [PMID: 37723468 PMCID: PMC10507833 DOI: 10.1186/s12886-023-03117-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Pediatric uveitis may cause severe impairment of vision in children and affect their quality of life as well as cognitive ability. This study aims to evaluate the functional vision, visual-related and health-related quality of life, and cognitive ability in pediatric uveitis. METHODS Children with uveitis aged 5-16 years old completed six validated instruments to assess functional visual ability with Cardiff Visual Ability Questionnaire for Children (CVAQC), vision-related quality of life with Impact of Vision Impairment for Children (IVI-C), health-related quality of life with Pediatric Quality of Life Inventory (PedsQL), cognitive ability with Chinese Wechsler Intelligence Scale for Children (C-WISC), and depression and anxiety evaluation with Hospital Anxiety and Depression Scale (HAD). RESULTS The CVAQC, IVI-C, and PedsQL scores of pediatric uveitis were significantly lower than that of normal levels. Full-scale intelligence quotient (IQ) and performance IQ were significantly lower in pediatric uveitis patients with impaired vision in their best eye (visual acuity < 0.3) compared to those with a vision equal to or better than 0.3. Verbal IQ was significantly lower in male pediatric uveitis patients with impaired vision compared to those with a vision equal to or better than 0.3. Additionally, parents of pediatric uveitis patients with impaired vision generally had lower educational levels than parents of those with a vision equal to or better than 0.3. CONCLUSIONS Impaired vision caused by pediatric uveitis has a significant impact on children's functional visual ability and quality of life. The development of cognitive function in pediatric uveitis is also significantly hindered.
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Grants
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- CSTC, 2008CA5003 Chongqing Key Laboratory of Ophthalmology
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- cstc2014pt-sy10002 Chongqing Science & Technology Platform and Base Construction Program
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- CSTC2021jscx-gksb-N0010 Key Project of Chongqing Science and Technology Bureau
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- 81970832 National Natural Science Foundation of China
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- cstc2021jcyj-msxmX0967 Natural Science Foundation of Chongqing Science and Technology Bureau
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2019 Chongqing Outstanding Scientists Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
- 2018 the Chongqing Chief Medical Scientist Project
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Affiliation(s)
- Wenjuan Wan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Zhijun Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Yan Xun
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Kun Yi
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Ying Zhu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Yanlin Pu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Chunjiang Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Yao Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing Eye Institute, Chongqing, P. R. China.
- The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, 400016, Chongqing, P.R. China.
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Sivakoti P, Swaminathan M, Magesan K, Pyare R, George AE, Ganesh SK, Biswas J, Dutta Majumder P. Visual outcome in pediatric uveitis: A retrospective data review in 277 children. Indian J Ophthalmol 2023; 71:2158-2161. [PMID: 37203097 PMCID: PMC10391450 DOI: 10.4103/ijo.ijo_1993_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose This study aimed to describe visual outcomes in cases of pediatric uveitis in an Indian population and to analyze various factors affecting these outcomes. Methods Single-center, retrospective chart review of 277 cases of uveitis in patients under the age of 18 years. Variables assessed included age and sex distribution, anatomical location of uveitis, systemic associations, complications, and various treatment strategies used, including long-term immunomodulation and surgical management of complications if required. The main outcome was the final visual acuity. Results At the final visit, 51.5% of the eyes showed improvement in the final visual acuity, while vision remained stable in 28.7% and 19.7% of the eyes showed worsening of vision at the final follow-up. A total of 19.4% of patients were blind in at least one eye at the final visit, and 16 patients (5.77%) remained bilaterally blind at the final follow-up. The presence of cataract (p = 0), posterior uveitis (p = 0.005), and retinal detachment (p = 0.014) were the most significant risk factors for predicting worse visual outcomes. More than half (65.7%) of patients reported a complication at some point in their follow-up, and the most common complication was cataract. In total, 50.9% of patients required long-term immunomodulatory therapy. Conclusion Pediatric uveitis remains a challenging condition to treat and follow-up, and the visual outcome remains guarded for most patients.
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Affiliation(s)
| | - Meenakshi Swaminathan
- Department of Strabismus and Pediatric Ophthalmology Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kowsigan Magesan
- Department of Optometry, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Richa Pyare
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Amala E George
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sudha K Ganesh
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Yalçındağ FN, Köse HC, Temel E. Comparative study of laser flare photometry versus slit-lamp cell measurement in pediatric chronic non-infectious anterior uveitis. Eur J Ophthalmol 2023; 33:382-390. [PMID: 35708177 DOI: 10.1177/11206721221107303] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the role of laser flare photometry (LFP) for monitoring the course of intraocular inflammation in children with chronic anterior uveitis. METHODS Seventy-six eyes of 43 children with non-infectious chronic anterior uveitis were reviewed retrospectively. RESULTS The median follow-up was 48.6 ± 23.1 months. Patients on immunosuppressive treatment at last follow-up, showed significantly higher flare values than patients who discontinued treatment (20.47 ± 15.49 vs. 6.33 ± 4.87 p < 0.001). The higher LFP values were correlated with the duration of immunosuppressive treatment, total duration of topical corticosteroid use and the risk for development of ocular complications at all follow-ups (all p < 0.001). No significant correlation was found between the AC cell grades and the duration of immunosuppressive treatment, topical corticosteroid use and the prevalence of complications. CONCLUSION LFP measurements have a predictive value of monitoring the course of uveitis and the occurrence of ocular complications, and it should be considered as a primary modality to monitor intraocular inflammation in children with chronic anterior uveitis.
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Affiliation(s)
- F Nilüfer Yalçındağ
- 63990Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Helin Ceren Köse
- 63990Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Emine Temel
- 63990Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Myopia and Other Visual Disorders in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158912. [PMID: 35897282 PMCID: PMC9332575 DOI: 10.3390/ijerph19158912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 12/10/2022]
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Alzyoud R, Alsuwaiti M, Maittah H, Aladaileh B, Nobani M, Farhan A, Alqurieny H, Khatatbeh A, Habahbeh Z. Pediatric Noninfectious Uveitis in a Tertiary Referral Center in Jordan: Clinical Spectrum and Immunomodulatory Treatment. Cureus 2022; 14:e25841. [PMID: 35720782 PMCID: PMC9191259 DOI: 10.7759/cureus.25841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives This study aims to describe the clinical, etiological, and treatment features of noninfectious uveitis in Jordanian children in a single center. Methods A retrospective, observational analysis of medical records of pediatric patients who were diagnosed with noninfectious uveitis from 2015 to 2020 at pediatric rheumatology and ophthalmology clinics at Queen Rania Children’s Hospital, Amman, Jordan, was conducted. All patients were below 14 years of age at diagnosis. The collected data included age at diagnosis, anatomical location of uveitis, laterality, associated systemic disease, and used medications. Results Overall, 96 patients were included in this cohort (41 males and 55 females), with a mean age at diagnosis of 8.4±2.4 years. Anterior uveitis (44.8%) was the commonest anatomical location. Based on laterality, bilateral uveitis was reported in 59.3% of all patients. Idiopathic uveitis (46.9%) and juvenile idiopathic arthritis-associated uveitis (JIAU) (35.5%) were the most common diagnoses. Of the children with idiopathic uveitis, 47% had panuveitis, while 61.7% of the children with JIAU had chronic anterior uveitis. Posterior synechiae were the most common complication (12.5%). Patients with refractory uveitis received infliximab (29.1%) and adalimumab (4.1%). Conclusion To the best of our knowledge, this is the first report on noninfectious uveitis in Jordanian children. Compared with other regional and international published reports, JIAU and idiopathic uveitis were the most common diagnoses. To obtain more details on noninfectious uveitis characteristics, a population-based rather than a single-center study is needed in Jordan.
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Zhao NO, Crowell EL. Epidemiology and Long-term Sequelae of Pediatric Uveitis. Int Ophthalmol Clin 2022; 62:131-142. [PMID: 34965231 DOI: 10.1097/iio.0000000000000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Maleki A, Anesi SD, Look-Why S, Manhapra A, Foster CS. Pediatric uveitis: A comprehensive review. Surv Ophthalmol 2021; 67:510-529. [PMID: 34181974 DOI: 10.1016/j.survophthal.2021.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
Pediatric uveitis accounts for 5-10% of all uveitis. Uveitis in children differs from adult uveitis in that it is commonly asymptomatic and can become chronic and cause damage to ocular structures. The diagnosis might be delayed for multiple reasons, including the preverbal age and difficulties in examining young children. Pediatric uveitis may be infectious or noninfectious in etiology. The etiology of noninfectious uveitis is presumed to be autoimmune or autoinflammatory. The most common causes of uveitis in this age group are idiopathic and juvenile idiopathic arthritis-associated uveitis. The stepladder approach for the treatment of pediatric uveitis is based on expert opinion and algorithms proposed by multidisciplinary panels. Uveitis morbidities in pediatric patients include cataract, glaucoma, and amblyopia. Pediatric patients with uveitis should be frequently examined until remission is achieved. Once in remission, the interval between follow-up visits can be extended; however, it is recommended that even after remission the child should be seen every 8-12 weeks depending on the history of uveitis and the medications used. Close follow up is also necessary as uveitis can flare up during immunomodulatory therapy. It is crucial to measure the impact of uveitis, its treatment, and its complications on the child and the child's family. Visual acuity can be considered as an acceptable criterion for assessing visual function. Additionally, the number of cells in the anterior chamber can be a measure of disease activity. We review different aspects of pediatric uveitis. We discuss the mechanisms of noninfectious uveitis, including autoimmune and autoinflammatory etiologies, and the risks of developing uveitis in children with systemic rheumatologic diseases. We address the risk factors for developing morbidities, the Standardization of Uveitis Nomenclature (SUN) criteria for timing and anatomical classifications, and describe a stepladder approach in the treatment of pediatric uveitis based on expert opinion and algorithms proposed by multi-disciplinary panels. In this review article, We describe the most common entities for each type of anatomical classification and complications of uveitis for the pediatric population. Additionally, we address monitoring of children with uveitis and evaluation of Quality of Life.
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Affiliation(s)
- Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Sydney Look-Why
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA; Harvard Medical School, Department of Ophthalmology, Boston, MA, USA.
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Yildiz M, Haslak F, Adrovic A, Sahin S, Koker O, Barut K, Kasapcopur O. Pediatric Behçet's Disease. Front Med (Lausanne) 2021; 8:627192. [PMID: 33614684 PMCID: PMC7886701 DOI: 10.3389/fmed.2021.627192] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Behçet's Disease (BD) is a systemic vasculitis firstly described as a disorder causing aphthous lesion in oral and genital mucosae and uveitis. The disease has an extremely unique distribution characterized by the highest incidence in communities living along the historical Silk road. Although our understanding of the etiopathogenesis of BD has expanded over time, there are still lots of unidentified points in the underlying mechanisms of the disease. The accepted opinion in the light of the current knowledge is that various identified and/or unidentified infectious and/or environmental triggers can take a role as a trigger in individuals with genetic susceptibility. Although the disease usually develops in young adulthood, it is reported that about 15-20% of all Behçet's patients develop in childhood. Pediatric BD differs from adult BD not only with the age of onset but also in the frequency and distribution of clinical findings, disease severity and outcome. While gastrointestinal system involvement, neurological findings, arthralgia and positive family history are more common in children, genital lesions and vascular lesions are more common in adult patients. In addition, a better disease outcome with lower severity score and activity index has been reported in children. The diagnosis of the disease is made according to clinical findings. It can be challenging to diagnose the disease due to the absence of a specific diagnostic test, and the long time interval from the first finding of the disease to the full-blown disease phenotype in pediatric cases. Therefore, many classification criteria have been proposed so far. The widely accepted ones are proposed by the International Study Group. The new sets of classification criteria which is the only one for pediatric BD were also developed for pediatric cases by the PEDBD group. The primary goal for the treatment is preventing the organ damages by suppressing the ongoing inflammation and forestalling the disease flares. The treatment of the BD can be onerous due to its multisystemic nature and a multidisciplinary approach is essential for the management of the patients. In this review article, the definition, clinical findings, epidemiology, etiopathogenesis, and treatment will be discussed.
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Affiliation(s)
| | | | | | | | | | | | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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14
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Ponti R, Mastrolia MV, Simonini G. Non-infectious Chronic Uveitis in Childhood: Assessment and Treatment in the Biological Era. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2021. [DOI: 10.1007/s40674-020-00166-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Qu Y, Zhao C, Pei M, Liang A, Gao F, Zhang M. Anterior Segment Inflammation in Pediatric Uveitis Is Associated with Reduced Retinal Vascular Density as Quantified by Optical Coherence Tomography Angiography. Ocul Immunol Inflamm 2020; 30:392-396. [PMID: 32976043 DOI: 10.1080/09273948.2020.1803923] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To analyze the retinal capillary vascular density (VD) as quantified by optical coherence tomography angiography (OCTA) in patients with pediatric uveitis. METHODS OCTA images of 32 pediatric uveitis patients and 30 normal controls (NC) were obtained retrospectively. The foveal avascular zone (FAZ) area, VDs in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were analyzed and compared between active and quiescent uveitic eyes, contralateral eyes and NC eyes. RESULTS Compared with NCs, the VDs in the SCP and DCP were significantly reduced in eyes with both active and quiescent pediatric uveitis (P < .05).The SFCT was increased significantly in the active group relative to the quiescent group and NC groups (P < .05). In contrast, no significant differences were observed in the FAZ and CMT (all P > .05). CONCLUSIONS Our quantitative OCTA findings suggest that the posterior segment is affected during anterior segment recurrence in patients with pediatric uveitis.
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Affiliation(s)
- Yi Qu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chan Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Minghang Pei
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, China
| | - Anyi Liang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Gao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meifen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Abstract
PURPOSE Pediatric idiopathic uveitis typically shows anterior segment involvement. Whether retinal vasculitis is an important manifestation of this disease remains unknown and was therefore the subject of this study. METHODS This study was performed involving patients with pediatric idiopathic uveitis. Fundus fluorescein angiography was used to assess the presence of retinal vasculitis. RESULTS A total of 1,867 patients with pediatric uveitis were seen between December 2008 and January 2018, of whom 1,364 had undergone fundus fluorescein angiography examination. Idiopathic uveitis was the most common entity, accounting for 81.2%. Among these patients with idiopathic uveitis, 79.6% had retinal vasculitis in at least one eye. After 1-year treatment with oral prednisone mostly combined with cyclosporine, 76.3% patients in the retinal vasculitis group achieved control of their ocular inflammation, which was significantly lower as compared with 85.1% in those without (P = 0.008). Retinal vasculitis was an independent predictor for a lower probability of inflammation control after 1-year treatment. Visual function (best-corrected visual acuity > 20/25 in the better seeing eye) was worse in the retinal vasculitis group than in the control group after 5 years. CONCLUSION Almost 80% of patients with pediatric idiopathic uveitis show manifestations of retinal vasculitis, which is associated with a lower probability of inflammation control resulting in a worse visual prognosis.
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Non-Infectious Chronic Uveitis in Childhood: Assessment and Treatment in the Biological Era. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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A Cross-Sectional Online Survey Identifies Subspecialty Differences in the Management of Pediatric Cataracts Associated with Uveitis. Ophthalmol Ther 2020; 9:293-303. [PMID: 32157612 PMCID: PMC7196112 DOI: 10.1007/s40123-020-00245-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction To determine if differences exist between pediatric ophthalmologists and uveitis ophthalmologists in the treatment of pediatric uveitic cataracts and placement of intraocular lenses. Methods Uveitis ophthalmologists and pediatric ophthalmologists were surveyed via an online poll regarding their therapeutic management of pediatric uveitic cataract and intraocular lens (IOL) placement. Results Sixty-two responses from uveitis ophthalmologists and 47 responses from pediatric ophthalmologists were recorded. According to 79% of all responses, uveitis was not a contraindication for primary IOL implantation in patients with controlled intraocular inflammation. Pediatric ophthalmologists were more likely to respond that the presence of chronic juvenile idiopathic arthritis-associated iridocyclitis, pars planitis, or recurrent acute anterior uveitis is a contraindication for primary IOL implantation in pediatric cases with full control of intraocular inflammation. There was no consensus within either specialty with regard to the preferred IOL material for lens implantation. Uveitis ophthalmologists were more likely to report the use of intravenous and intravitreal steroids for perioperative treatment. In cataract surgery for a child with recurrent acute anterior uveitis, a higher percentage of uveitis ophthalmologists (71%) than pediatric ophthalmologists (50%) responded that the posterior capsule should be primarily opened. A higher percentage of uveitis ophthalmologists also stated that anterior vitrectomy should be performed at the time of cataract surgery in all three uveitis types. Conclusions Pediatric ophthalmologists and uveitis ophthalmologists have similar approaches to the management of pediatric uveitic cataract removal and IOL insertion, but several differences remain between these subspecialties. Continued collaboration between the subspecialties would be helpful to better develop consistent criteria to improve patient care. Electronic supplementary material The online version of this article (10.1007/s40123-020-00245-x) contains supplementary material, which is available to authorized users.
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Jari M, Shiari R, Salehpour O, Rahmani K. Epidemiological and advanced therapeutic approaches to treatment of uveitis in pediatric rheumatic diseases: a systematic review and meta-analysis. Orphanet J Rare Dis 2020; 15:41. [PMID: 32019589 PMCID: PMC7001204 DOI: 10.1186/s13023-020-1324-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background Despite the low prevalence of uveitis in pediatric rheumatic diseases, potential problems as well as high disease burden can complicate its management. In this review, we systematically assessed the epidemiological, etiological, and managerial aspects of uveitis in pediatric rheumatic diseases. Methods This current study was conducted in accordance with the established methods and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). We searched the manuscript databases, including Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane for all eligible studies in line with the considered keywords. We also conducted the statistical analysis using the Stata software. Results Considering studies focusing on uveitis in Juvenile Idiopathic Arthritis (JIA) yielded a pooled prevalence of 11.8% (95%CI: 11.2 to 12.4%) for uveitis following JIA. In this regard, the prevalence rate of uveitis related to Behçet,s disease and Systemic Lupus Erythematosus (SLE( was estimated to be 15.0 and 0.8%, respectively. The pooled response rate to Adalimumab and Infliximab was estimated to be 68.0% (95%CI: 65.4 to 70.6%), 64.7% (95%CI: 59.8 to 69.3%), respectively. The documents for the systematical assessment of other biological medications (e.g. Tocilizumab, Daclizumab and Rituximab) were inadequate; however, the mean response rate for these drugs was 59, 75 and 80%, respectively. Our meta-analysis showed a pooled response rate of 40.0% (95%CI, 36.0% to 44.2) to Methotrexate. Significant heterogeneity and significant diffusion bias were demonstrated by reviewing studies. Conclusions The pooled prevalence of uveitis in pediatric rheumatic diseases widely varied based on the underlying disease requiring more investigations in different subtypes of rheumatic diseases. The biologic medications, especially Adalimumab are the most effective treatments for uveitis in pediatric rheumatic diseases; however, a combination of the safe, available alternatives is preferred to achieve the most desirable treatment response.
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Affiliation(s)
- Mohsen Jari
- Department of Pediatric Rheumatology, Imam Hossein Children's Hospital. Isfahan University of Medical Sciences, Isfahan, Iran. .,Child Growth and Development Research Center, Research Institute for Primordial prevention of non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Reza Shiari
- Department of Pediatric Rheumatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Salehpour
- Negah Specialty Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Rahmani
- Department of Pediatric Rheumatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Yıldız M, Köker O, Adrovic A, Şahin S, Barut K, Kasapçopur Ö. Pediatric Behçet's disease - clinical aspects and current concepts. Eur J Rheumatol 2020; 7:S38-S47. [PMID: 31556871 PMCID: PMC7004268 DOI: 10.5152/eurjrheum.2019.19121] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/30/2019] [Indexed: 12/14/2022] Open
Abstract
Behçet's Disease was first described by a Turkish dermatologist, Hulusi Behçet, in 1937 as a triple symptom complex; aphthous stomatitis, genital ulcers, and uveitis. Today, in light of current trials and experiments, we know that the disease may have a wider involvement with a multisystemic recurrent course, causing significant morbidity and mortality. However, there are still unanswered questions, particularly about Pediatric Behçet's Disease. Although several immunological and genetic associations have been demonstrated, the real etiologic mechanism of the disease is unclear. The diagnosis is difficult due to its rarity in childhood, the lack of validation of the diagnostic criteria obtained from adult studies, and the inadequacy of large case-controlled studies. Also, the management is challenging and controversial due to the various geographic distribution of clinical spectrum. New therapeutic options under development in light of pathogenetic hypothesis seem to be promising.
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Affiliation(s)
- Mehmet Yıldız
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Oya Köker
- Department of Pediatric Rheumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Sezgin Şahin
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Özgür Kasapçopur
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
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21
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Hayworth JL, Turk MA, Nevskaya T, Pope JE. The frequency of uveitis in patients with juvenile inflammatory rheumatic diseases. Joint Bone Spine 2019; 86:685-690. [DOI: 10.1016/j.jbspin.2019.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 06/05/2019] [Indexed: 12/14/2022]
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Kim L, Li A, Angeles-Han S, Yeh S, Shantha J. Update on the management of uveitis in children: an overview for the clinician. EXPERT REVIEW OF OPHTHALMOLOGY 2019; 14:211-218. [PMID: 32831897 PMCID: PMC7437956 DOI: 10.1080/17469899.2019.1663731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/02/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Pediatric uveitis comprises a range of ocular inflammatory diseases that may lead to vision impairment, often due to ocular complications from the disease itself or side effects of therapies. The impact on vision, visual functioning, and vision-related quality-of-life over the lifetime horizon can be substantial, underscoring the importance of appropriate ophthalmic evaluation, diagnostic testing and treatment. This review focuses on the anatomic classification, laboratory diagnosis, associated systemic diseases, and management of pediatric uveitis. AREAS COVERED A review of the literature was performed to synthesize our current understanding of the anatomic classification of pediatric uveitis, disease epidemiology, associated systemic diseases, and management principles. We also review important corticosteroid-sparing strategies including non-biologic and biologic agents such as the anti-tumor necrosis factor (TNF)-alpha family of medications, given their key role in the treatment of pediatric uveitis, particularly juvenile idiopathic arthritis (JIA). Recent advances in the assessment of vision-related quality-of-life using the Effects of Youngsters' Eyesight on Quality of Life (EYE-Q) instrument are discussed. EXPERT OPINION Pediatric uveitis can lead to long-term vision impairment if not appropriately screened and treated. JIA is the most common systemic disease associated with uveitis, is typically asymptomatic, and thus requires rigorous screening to detect uveitis and avoid secondary ocular complications. While topical and systemic corticosteroids are useful for the acute treatment of uveitis, the disease chronicity of many pediatric uveitis syndromes including JIA, often warrants early escalation of therapy to immunosuppressive medications including methotrexate (MTX) and anti-TNF-alpha inhibitors. Future directions include an improved understanding of risk factors for uveitis and better metrics to evaluate the impact of disease on vision-related quality-of-life of pediatric uveitis patients.
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Affiliation(s)
- Lucas Kim
- Mercer University School of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Alexa Li
- Emory Eye Center, Emory University School of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sheila Angeles-Han
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Steven Yeh
- Emory Eye Center, Emory University School of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jessica Shantha
- Emory Eye Center, Emory University School of Medicine, University of Cincinnati, Cincinnati, Ohio
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Al-Haddad C, BouGhannam A, Abdul Fattah M, Tamim H, El Moussawi Z, Hamam RN. Patterns of uveitis in children according to age: comparison of visual outcomes and complications in a tertiary center. BMC Ophthalmol 2019; 19:137. [PMID: 31248388 PMCID: PMC6598272 DOI: 10.1186/s12886-019-1139-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 06/04/2019] [Indexed: 12/18/2022] Open
Abstract
Background Uveitis in the pediatric population is uncommon, accounting for 2 to 14% of all uveitis cases, yet resulting in significant ocular morbidity. A number of studies have focused on patterns and complications of uveitis in the pediatric age group (≤ 16 years). In this report, we studied children with uveitis syndromes focusing on demographics, anatomic distribution, etiologies, treatment, and complications. We additionally divided subjects into two age groups to look into any differential characteristics pertaining to the younger age group and the role of amblyopia as a cause of visual loss. Methods Retrospective chart review of 80 eyes of 49 uveitis patients aged ≤16 years. Subjects were categorized by age of onset into visually immature (≤8 years) and visually mature group (> 8 years). Data compared between the two age groups included demographics, disease characteristics, visual outcomes and complications. Results Idiopathic uveitis was the most common diagnosis (51%). Anterior uveitis complications (posterior synechiae and band keratopathy) were more common in the younger group (p = 0.002 and p = 0.03 respectively) while posterior uveitis manifestations (vitreous haze and vasculitis) were more common in the older age group (p = 0.04 and p < 0.001 respectively). Amblyopia was the most common cause of vision loss in the visually immature versus cataract in the visually mature. Conclusion Anterior uveitis and its complications were more common in visually immature group in our cohort. Amblyopia was identified as the main cause of visual loss in the younger population.
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Affiliation(s)
| | - Alaa BouGhannam
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | | | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Zeinab El Moussawi
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Rola N Hamam
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon. .,Ocular Immunology and Uveitis- Retina, American University of Beirut Medical Center, PO Box 110236, Beirut, Lebanon.
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Etiologic Spectrum and Follow-Up Results of Noninfectious Uveitis in Children: A Single Referral Center Experience. Arch Rheumatol 2019; 34:294-300. [PMID: 31598595 DOI: 10.5606/archrheumatol.2019.7253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/20/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate the etiologic spectrum, demographic features, and long-term follow-up results of children with noninfectious uveitis (NIU). Patients and methods Files of patients with NIU were reviewed between May 2010 and September 2017. The cohort consisted of 54 juvenile uveitis patients (26 males, 28 females; mean age 7.7 years; interquartile range [IQR] 9.2 years) with 93 affected eyes. Location of uveitis, laterality, age at onset of uveitis, complications of uveitis, duration of follow-up, associated systemic diseases, pertinent laboratory tests, medications used, and status of uveitis at the time of enrollment were recorded from the files. All patients had final systemic and ocular examination at the last month of enrollment. Results Twenty-seven patients (50.0%) had juvenile idiopathic arthritis (JIA), 17 (31.4%) had idiopathic uveitis, six (11.1%) had Behçet disease (BD), and four (7.5%) had tubulointerstitial nephritis and uveitis (TINU) syndrome. Median duration of follow-up for uveitis was 16 (IQR: 15) months. Anterior uveitis was seen in 81.4% of the patients (65.9% had bilateral and 34.1% had unilateral anterior uveitis). Bilateral intermediate uveitis was observed in 11.2% and bilateral panuveitis in 7.4% of the patients. At the time of enrollment, 45 uveitis patients (83.3%) were under remission. Complications of uveitis were observed in 18.5% of the patients. Conclusion Patients with JIA and BD should be regularly checked for uveitis. It is challenging to find an etiology in uveitis patients referred from ophthalmologists if initial questioning and examination do not reveal an overt rheumatologic disease. However, a simple urine test may help in establishing the diagnosis of TINU syndrome.
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Majumder PD, Sitaula RK, Biswas J. Pediatric Eales Disease: An Indian Tertiary Eye Center Experience. J Pediatr Ophthalmol Strabismus 2018; 55:270-274. [PMID: 29709043 DOI: 10.3928/01913913-20180213-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/21/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the clinical profiles, etiologies, treatment modalities, and outcomes for Eales disease in patients younger than age 16 years in India. METHODS Retrospective review of medical records of patients with Eales disease who had a minimum 5-year follow-up period. RESULTS A total of 25 eyes of 13 patients were included. Of these 13 patients, 12 (94%) had bilateral Eales disease and 11 (84.6%) were men. Mean patient age was 14.1 years (range: 11 to 16 years). Diminution of vision (36%) was the most common presenting complaint, followed by both diminutions of vision and floaters (32%). Sclerosed vessels were seen in all eyes, and 21 (84%) eyes had active periphlebitis at presentation. Neovascularization elsewhere was seen in 20 (80%) eyes and neovascularization of the optic disc was seen in 1 (4%) eye. Veno-venous shunts were found in 12 (48%) eyes, and 18 (72%) eyes had vitreous hemorrhage. All eyes received photocoagulation; 84.6% of patients received oral steroids, with 7.7% of patients treated with azathioprine and 38.4% treated with anti-tubercular therapy. Vitrectomy was performed in 36% of eyes for non-clearing vitreous hemorrhage and tractional retinal detachment. Vision improved in 7 (28%) eyes, was stable in 12 (48%) eyes, and worsened in 6 (24%) eyes. Recurrence of the disease more than five times during the 5-year follow-up period occurred in 20% of patients. CONCLUSIONS Recurrent vasculitis and vitreous hemorrhage in children should raise the suspicion of pediatric Eales disease. [J Pediatr Ophthalmol Strabismus. 2018;55(4):270-274.].
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Souto FMS, Giampietro BV, Takiuti JT, Campos LMA, Hirata CE, Yamamoto JH. Clinical features of paediatric uveitis at a tertiary referral centre in São Paulo, SP, Brazil. Br J Ophthalmol 2018; 103:bjophthalmol-2018-312313. [PMID: 29907630 DOI: 10.1136/bjophthalmol-2018-312313] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/02/2018] [Indexed: 11/04/2022]
Abstract
AIMS To analyse the clinical features, systemic associations, treatment and visual outcomes of uveitis in children from a referral centre in São Paulo, Brazil. METHODS Clinical records of patients under 16 years old who attended the Uveitis Service, Hospital das Clinicas, Faculdadede Medicina, Universidade de São PauloFMUSP, between April and September 2017, were reviewed retrospectively. Patients with incomplete medical records, previous ocular trauma, or less than six6 months of follow-up were excluded. RESULTS Thirty-nine children (25 female/14 male) were included. There was predominance of bilateral (89.7%), asymptomatic (56.4%) and recurrent/chronic cases (84.6%). The mean age at study inclusion was 10.7±3.4 years (range 3-16 years). Improvement or preservation of visual acuity (VA) was observed in 27 patients (84%); VA was not informed in 8 patients. Patients were referred early to tertiary centre (55% within 6 months of uveitis diagnosis). Anterior uveitis was the most common involvement (46%), followed by intermediate uveitis (26%). Juvenile idiopathic arthritis (JIA)-associated uveitis (41%) and immune-mediated intermediate uveitis (25.6%) were the principal non-infectious conditions; ocular toxoplasmosis (7.7%) and toxocariasis (5.1%) were the most common infectious conditions. Ocular complications were observed at first visit in 46% of patients and in 90% during final evaluation. Oral prednisone, immunosuppressive therapy (IMT) and/or biologic agents were used in all non-infectious conditions (32 children, 82%); IMT and/or biologic agents were used in all patients with JIA-associated uveitis and in 50% of patients with immune-mediated intermediate uveitis. CONCLUSION Paediatric patients with uveitis are referred early to this centre and, although severe, adequate management with systemic IMT may preserve VA.
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Affiliation(s)
| | | | - Julia Thiemi Takiuti
- Department of Ophthalmology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucia Maria Arruda Campos
- Pediatric Rheumatology Unit, Pediatric Department, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos Eduardo Hirata
- Department of Ophthalmology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Joyce Hisae Yamamoto
- Department of Ophthalmology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Abstract
Pediatric uveitis differs from adult-onset uveitis and is a topic of special interest because of its diagnostic and therapeutic challenges. Children with uveitis are often asymptomatic and the uveitis is often chronic, persistent, recurrent, and resistant to conventional treatment. Anterior uveitis is the most common type of uveitis in children; the prevalence of intermediate, posterior, and panuveitis varies geographically and among ethnic groups. Regarding etiology, most cases of pediatric uveitis are idiopathic but can be due to systemic inflammatory disorders, infections, or a manifestation of masquerade syndrome. Ocular complications include cataracts, hypotony or glaucoma, band keratopathy, synechiae formation, macular edema, optic disc edema, choroidal neovascular membranes, and retinal detachment. These complications are often severe, leading to irreversible structural damage and significant visual disability due to delayed presentation and diagnosis, persistent chronic inflammation from suboptimal treatment, topical and systemic corticosteroid dependence, and delayed initiation of systemic disease‒modifying agents. Treatment for noninfectious uveitis is a stepwise approach starting with corticosteroids. Immunomodulatory therapy should be initiated in cases where quiescence cannot be achieved without steroid dependence. Patients should be monitored regularly for complications of uveitis along with systemic and ocular adverse effects from treatments. The goals are to achieve steroid-free durable remission, to reduce the risk of sight-threatening complications from the uncontrolled ocular inflammation, and to avoid the impact of lifelong burden of visual loss on the child and their family. Multidisciplinary management will ensure holistic care of affected children and improve the support for their families.
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Affiliation(s)
| | - Jessy Choi
- Department of Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust and Sheffield Children NHS Foundation Trust, Sheffield, United Kingdom
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
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Ferrara M, Eggenschwiler L, Stephenson A, Montieth A, Nakhoul N, Araùjo-Miranda R, Foster CS. The Challenge of Pediatric Uveitis: Tertiary Referral Center Experience in the United States. Ocul Immunol Inflamm 2018; 27:410-417. [PMID: 29333911 DOI: 10.1080/09273948.2017.1420202] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose: To describe the distribution, clinical findings, visual outcomes, treatment, and complications of children with uveitis at a tertiary referral ophthalmic center. Methods: Retrospective cohort study. We reviewed the medical records of all patients ≤16 years with uveitis referred to Massachusetts Eye Research and Surgery Institution from March 2005 to July 2016. Results: Of 286 included children, 62.24% were female. Mean age of onset was 8.4 years. The uveitis was mainly anterior (61.9%), recurrent (68.53%), bilateral (81.82%), and noninfectious (96.5%). Idiopathic cases accounted for 51.4%. The most frequent systemic association was juvenile idiopathic arthritis (34.96%). The majority of patients (78.32%) experienced complications. All patients, except one, needed systemic therapy. Conclusion: Pediatric uveitis is challenging to diagnose and manage, with frequent and potentially severe complications. Most cases were bilateral, recurrent, and idiopathic. Prompt referral to uveitis-specialized centers and an appropriate systemic therapy are mandatory for good visual outcomes.
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Affiliation(s)
- Mariantonia Ferrara
- a Massachusetts Eye Research and Surgery Institution , Waltham , Massachusetts , USA.,b The Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA.,c Department of Neuroscience, Reproductive and Odontostomatological Science , Federico II University , Naples , Italy
| | - Laura Eggenschwiler
- a Massachusetts Eye Research and Surgery Institution , Waltham , Massachusetts , USA.,b The Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA
| | - Andrew Stephenson
- a Massachusetts Eye Research and Surgery Institution , Waltham , Massachusetts , USA.,b The Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA
| | - Alyssa Montieth
- a Massachusetts Eye Research and Surgery Institution , Waltham , Massachusetts , USA.,b The Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA
| | - Nakhoul Nakhoul
- d Department of Ophthalmology, Barich Padeh Medical Center , Poriya , Israel
| | - Rafael Araùjo-Miranda
- e Faculty of Medicine in the Galilee , Bar-Ilan University , Safed , Israel.,f FISABIO Oftalmologia Medica , Valencia , Spain
| | - C Stephen Foster
- a Massachusetts Eye Research and Surgery Institution , Waltham , Massachusetts , USA.,b The Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA.,g Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA
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Sinkar S, House P, Greer D, Lam GC. ‘
Bung’ eye: ocular inflammation caused by sandfly bite. Clin Exp Ophthalmol 2017; 45:924-925. [DOI: 10.1111/ceo.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/25/2017] [Accepted: 05/02/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Swati Sinkar
- Princess Margaret Hospital for Children Roberts Road; Subiaco Western Australia Australia
| | - Philip House
- Princess Margaret Hospital for Children Roberts Road; Subiaco Western Australia Australia
| | - David Greer
- Princess Margaret Hospital for Children Roberts Road; Subiaco Western Australia Australia
| | - Geoffrey C Lam
- Princess Margaret Hospital for Children Roberts Road; Subiaco Western Australia Australia
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Retrospective Study Evaluating Treatment Decisions and Outcomes of Childhood Uveitis Not Associated with Juvenile Idiopathic Arthritis. J Pediatr 2017; 186:131-137.e1. [PMID: 28457525 DOI: 10.1016/j.jpeds.2017.03.052] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/24/2017] [Accepted: 03/24/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate treatment, ocular complications and outcomes of children with pediatric uveitis not associated with juvenile idiopathic arthritis. STUDY DESIGN This was a retrospective chart review of pediatric uveitis in children under 16 years of age, recruited from the pediatric rheumatology department at Bicêtre Hospital from 2005 to 2015. Patients with juvenile idiopathic arthritis-associated and infectious uveitis were excluded. We used the Standardization of Uveitis Nomenclature Working Group to classify uveitis, disease activity, and treatment end points. RESULTS We enrolled 56 patients and 102 affected eyes. The mean age at diagnosis was 10 ± 3.5 years (range 3-15), and the mean follow-up 4.2 ± 3.3 years (1-15). The main diagnoses were idiopathic (55%), Behçet disease (15%), and sarcoidosis (5%). The main localization was panuveitis in 44 of 102 eyes (43%). Corticosteroid sparing treatment was needed in 62 of 102 eyes (60%). Second-line therapies included methotrexate and azathioprine, and the third-line therapy was a biologic agent, mainly infliximab, in 33 of 102 eyes (32%). Infliximab achieved uveitis inactivity in 14 of 18 eyes (80%), in all etiologies. Severe complications were present in 68 of 102 eyes (67%). The most common were synechiae 33% of eyes, cataract (20%), and macular edema (25%). Of these, 37% were present at diagnosis. Remission was achieved in 22 of 102 eyes (21%). CONCLUSIONS Conventional therapies were insufficient to treat many of the cases of posterior or panuveitis. This study underlines the need for earlier and more aggressive treatment and antitumor necrosis factor-α therapy was rapidly efficient in most cases of refractory uveitis.
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Annamalai R, Biswas J. Patterns of Intermediate Uveitis in Children Presenting at a Tertiary Eye Care Center in South India. Middle East Afr J Ophthalmol 2017; 24:94-99. [PMID: 28936054 PMCID: PMC5598310 DOI: 10.4103/meajo.meajo_264_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To study the patterns of intermediate uveitis in the pediatric age group in a referral eye care center in South India. METHODS This is a study of twenty consecutive patients under 16 years of age with intermediate uveitis, conducted at a tertiary referral center. Numerous variables were assessed, including age and gender distribution, laboratory data, the presence of systemic diseases, onset and course of ocular inflammation, clinical features, their complications, therapeutic strategies with their outcomes, remission, final visual acuity (VA), and characteristics associated with poor visual outcome. RESULTS Bilateral involvement was observed in 80% of the patients. Remission was observed in five out of 7 patients (78%) with completed follow-up of 5 years. Final VA improved by at least two lines in 11 patients, remained stable in 6 patients, and worsened in 3 patients. The etiological diagnosis showed one patient with Bechet's disease, one with juvenile idiopathic arthritis, 1 with human leukocyte antigen B27 associated uveitis, 9 with laboratory proven tuberculosis, and 3 with sarcoidosis and 5 where it was idiopathic. The mean follow-up was 4.8 years (range 3-8 years). Cataract was the most frequent complication observed (40%). Glaucoma, choroidal neovascularization, and amblyopia accounted for worsening of vision in three patients. CONCLUSION Median time of development of complications is about 3 years based on our study. Intermediate uveitis of childhood might exhibit a self-limiting course after several years. Visual recovery is good in the majority, and visual loss is limited despite the high rate of ocular complications.
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Affiliation(s)
- Radha Annamalai
- Deparment of Uveitis and Ocular Inflammation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Kaur S, Aggarwal K, Agarwal A, Suri D, Gupta A, Singh R, Bansal R, Singh S, Singh N, Gupta A, Gupta V. Clinical Course and Outcomes of Pediatric Tubercular Uveitis in North India. Ocul Immunol Inflamm 2017; 26:859-864. [PMID: 28318350 DOI: 10.1080/09273948.2017.1296579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Savleen Kaur
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanika Aggarwal
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepti Suri
- Department of Pediatric Allergy Immunology Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anju Gupta
- Department of Pediatric Allergy Immunology Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Reema Bansal
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surjit Singh
- Department of Pediatric Allergy Immunology Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nirbhai Singh
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amod Gupta
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Cunningham ET, Smith JR, Tugal-Tutkun I, Rothova A, Zierhut M. Uveitis in Children and Adolescents. Ocul Immunol Inflamm 2017; 24:365-71. [PMID: 27471956 DOI: 10.1080/09273948.2016.1204777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Emmett T Cunningham
- a Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA.,b The Department of Ophthalmology , Stanford University School of Medicine , Stanford , California , USA.,c The Francis I. Proctor Foundation , UCSF School of Medicine , San Francisco , California , USA
| | - Justine R Smith
- d Eye & Vision Health , Flinders University School of Medicine , Adelaide , South Australia , Australia
| | - Ilknur Tugal-Tutkun
- e Department of Ophthalmology , Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey
| | - Aniki Rothova
- f Department of Ophthalmology ; Erasmus Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Manfred Zierhut
- g Centre for Ophthalmology , University Tuebingen , Tuebingen , Germany
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Ganesh SK, Mistry S. Phacoemulsification with Intraocular Lens Implantation in Pediatric Uveitis: A Retrospective Study. Ocul Immunol Inflamm 2016; 26:305-312. [PMID: 27598822 DOI: 10.1080/09273948.2016.1206944] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To analyze the outcome of phacoemulsification with primary posterior chamber intraocular lens (IOL) implantation without primary posterior capsulorhexis in older children with uveitis. METHODS Retrospective study of children with uveitis who underwent phacoemulsification with IOL implantation between January 2006 and May 2014. RESULTS Twenty-one eyes of 16 children were included. Mean age at cataract surgery was 10.9 years. Juvenile idiopathic arthritis was associated in 37.5%, tuberculosis in 18.7%, Vogt Koyanagi Harada disease in 6.2%, and idiopathic uveitis in 37.5%. Anterior uveitis occurred in 8/21 eyes, intermediate uveitis in 9/21 eyes, and panuveitis in 4/21 eyes. Mean follow-up was 29.9 months. Posterior capsule opacification occurred in 15 eyes, glaucoma in two eyes, choroidal neovascular membrane in one eye, and cystoid macular edema in five eyes. At the last follow up, 19/21 eyes had improved vision and 14 had 20/40 or better vision. CONCLUSION Tight perioperative inflammatory control with immunosuppression may result in good vision after phacoemulsification and IOL implantation without posterior capsulorrhexis in older children with uveitic cataract.
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Affiliation(s)
- Sudha K Ganesh
- a Medical Research Foundation , Sankara Nethralaya, Chennai , India
| | - Saurabh Mistry
- a Medical Research Foundation , Sankara Nethralaya, Chennai , India
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Abdala-Figuerola A, Bobadilla Mayorquín RY, Lichtinger A. Challenges in the diagnosis of Fuchs uveitis syndrome in children. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1210005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Le Reun S, Poulain M, Perlat A, Mortemousque B. Apport du TEP-scan dans le diagnostic positif de la sarcoïdose, au cours du bilan d’uvéite indéterminée. J Fr Ophtalmol 2015; 38:103-11. [DOI: 10.1016/j.jfo.2014.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 09/11/2014] [Accepted: 09/17/2014] [Indexed: 11/30/2022]
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Chen YW, Yu HJ, Poon YC, Kuo HK. Ocular post-transplant lymphoproliferative disorder. Taiwan J Ophthalmol 2014; 5:140-142. [PMID: 29018687 PMCID: PMC5602712 DOI: 10.1016/j.tjo.2014.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 05/26/2014] [Accepted: 06/09/2014] [Indexed: 11/15/2022] Open
Abstract
We report a case of an iris tumor with muttonfat keratic precipitates in a young patient after liver transplantation surgery. A 6yearold girl underwent liver transplantation for congenital biliary atresia and was subsequently immunosuppressed with oral cyclosporine. We examined her 5 years after transplantation because of a "white nodule in her left eye," which had been detected by her father one day before visiting our clinic. Ophthalmological examinations revealed symmetric visual acuity and normal afferent papillary reflex. Slitlamp examination revealed a depigmented iris nodule approximately3 × 2 mm with muttonfat keratic precipitates in the anterior chamber. Fundus examination was unremarkable, and computed tomography (CT) of the head, neck, and abdomen showed normal findings. Based on the suspicion of post-transplant lymphoproliferative disorder (PTLD), therapy was initiated, which included tapering cyclosporine and topical mydriatics. After 2.5 months, the lesion resolved and no more muttonfat keratic precipitates were identified in the anterior chamber. In this PTLD case, the patient presented with an iris nodule and muttonfat keratic precipitates, and the ocular PTLD presentation resolved spontaneously after tapering cyclosporine.
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Affiliation(s)
- Yun-Wen Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hun-Ju Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chieh Poon
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Abstract
Pediatric uveitis is a topic of special interest not only because of the unique diagnostic and therapeutic challenges but also because of the lifetime burden of vision loss if the problem is not adequately treated, as well as the economic and psychological toll on the family. Often, uveitis in children is discovered as part of a routine eye exam; this silent, insidious inflammation can be difficult to treat and can lead to further complications if not handled skillfully. Corticosteroids have long been the mainstay of therapy; however, the significant associated side effects mandate a corticosteroid-sparing therapeutic regimen in pursuit of remission. In this review, we cover the therapeutic options for pediatric uveitis, specifically focusing on the most common non-infectious varieties, juvenile idiopathic arthritis-associated uveitis and pars planitis.
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Affiliation(s)
- Bailey A. Wentworth
- Massachusetts Eye Research and Surgery Institution (MERSI)5 Cambridge Center, Cambridge, MA 02142USA
- Ocular Immunology and Uveitis Foundation348 Glen Road, Weston, MA 02493USA
| | - Clovis A. Freitas-Neto
- Massachusetts Eye Research and Surgery Institution (MERSI)5 Cambridge Center, Cambridge, MA 02142USA
- Ocular Immunology and Uveitis Foundation348 Glen Road, Weston, MA 02493USA
| | - C. Stephen Foster
- Massachusetts Eye Research and Surgery Institution (MERSI)5 Cambridge Center, Cambridge, MA 02142USA
- Ocular Immunology and Uveitis Foundation348 Glen Road, Weston, MA 02493USA
- Department of Ophthalmology, Harvard Medical School25 Shattuck Street, Boston, MA 02115USA
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