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Ocular Immunology and Inflammation May 2024To characterize and describe clinical experience with childhood-onset non-infectious uveitis.
OBJECTIVE
To characterize and describe clinical experience with childhood-onset non-infectious uveitis.
STUDY DESIGN
A multicenter retrospective multidisciplinary national web-based registry of 507 patients from 21 hospitals was analyzed. Cases were grouped as immune disease-associated (IMDu), idiopathic (IDIu) or ophthalmologically distinct. Characteristics of juvenile idiopathic arthritis-associated (non-HLA-B27-related) uveitis (JIAu), IDIu, and pars planitis (PP) were compared.
RESULTS
IMDu (62.3%) and JIAu (51.9%) predominated in young females; and IDIu (22.7%) and PP (13.6%) in older children, without sex imbalance. Ocular complications occurred in 45.3% of cases (posterior synechiae [28%], cataracts [16%], band keratopathy [14%], ocular hypertension [11%] and cystoid macular edema [10%]) and were associated with synthetic (86%) and biologic (65%) disease-modifying antirheumatic drug (DMARD) use. Subgroups were significantly associated ( < 0.05) with different characteristics. JIAu was typically anterior (98%), insidious (75%), in ANA-positive (69%), young females (82%) with fewer complications (31%), better visual outcomes, and later use of uveitis-effective biologics. In contrast, IDIu was characteristically anterior (87%) or panuveitic (12.1%), with acute onset (60%) and more complications at onset (59%: synechiae [31%] and cataracts [9.6%]) and less DMARD use, while PP is intermediate, and was mostly bilateral (72.5%), persistent (86.5%) and chronic (86.8%), with more complications (70%; mainly posterior segment and cataracts at last visit), impaired visual acuity at onset, and greater systemic (81.2%), subtenon (29.1%) and intravitreal (10.1%) steroid use.
CONCLUSION
Prognosis of childhood uveitis has improved in the "biologic era," particularly in JIAu. Early referral and DMARD therapy may reduce steroid use and improve outcomes, especially in PP and IDIu.
PubMed: 38728578
DOI: 10.1080/09273948.2024.2336609 -
Ocular Immunology and Inflammation Nov 2021: To analyze the demographic characteristics, clinical features, ocular complications, and visual outcome of pediatric patients with uveitis.: Retrospective evaluation...
: To analyze the demographic characteristics, clinical features, ocular complications, and visual outcome of pediatric patients with uveitis.: Retrospective evaluation of medical records.: The study included 156 eyes of 93 patients. Fifty-three patients were female and 40 were male. Mean age at onset of the uveitis was 9.54 ± 4.29 years. The mean follow-up period was 29.88 ± 28.97 months. Anterior uveitis (49.5%) was the most common anatomic type followed by panuveitis (21.5%), intermediate uveitis (18.3%), and posterior uveitis (10.7%). Juvenile idiopathic arthritis (JIA) was the most common leading systemic disease (18.3%) followed by Behçet disease (11.8%). It was detected at least one complication in 53 (34.0%) eyes at presentation. Mean LogMAR visual acuity was found <0.3 in 136 (87.2%) eyes at final examination.: The most common localization was the anterior segment and the most common etiologic relationship was JIA. Visual outcome could be satisfactory with early and appropriate treatment.
Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Infant; Male; Retrospective Studies; Tertiary Care Centers; Turkey; Uveitis; Visual Acuity
PubMed: 32463707
DOI: 10.1080/09273948.2020.1758158 -
Mediators of Inflammation 2020In patients, an increase in the population of Th17-secreting cells negatively correlated with the abundance of both IFN--producing and T regulatory as well as suppressor...
Imbalance in PB IL-17-Secreting and Regulatory Cells in Pars Planitis Is Associated with Dysregulation of IFN--Secreting Cells, Especially in Patients with Clinical Complications.
RESULTS
In patients, an increase in the population of Th17-secreting cells negatively correlated with the abundance of both IFN--producing and T regulatory as well as suppressor cells, regarding all the phenotypes studied. Although a strong dependence of the PB Th1 cell compartment on the duration of the disease was observed, it was limited to the subgroup of patients with macular edema only. The frequency of B regulatory cells was unchanged compared to controls.
CONCLUSIONS
In pars planitis, the alterations in lymphocyte cell distribution affect primarily the T cell repertoire. The imbalance in PB Th1/Th17/Treg cells creates proinflammatory conditions, strengthening the suggestion that the immune background may play a role in pars planitis pathogenesis. Also, circulating Th1 level may be of potential clinical relevance in terms of prediction of a more severe course of the disease.
Topics: Adolescent; Adult; Aged; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Female; Flow Cytometry; Humans; Interferon-gamma; Interleukin-17; Male; Middle Aged; Pars Planitis; T-Lymphocytes, Regulatory; Th1 Cells; Th17 Cells; Young Adult
PubMed: 32801998
DOI: 10.1155/2020/9175083 -
Clinical Ophthalmology (Auckland, N.Z.) 2015The purpose of this study was to identify the causes, clinical features, and outcomes of intermediate uveitis, posterior uveitis, and panuveitis in patients managed in a...
BACKGROUND
The purpose of this study was to identify the causes, clinical features, and outcomes of intermediate uveitis, posterior uveitis, and panuveitis in patients managed in a mid-Atlantic tertiary care center.
METHODS
This was a retrospective observational study of intermediate uveitis, posterior uveitis, and panuveitis patients seen at the University of Virginia from 1984 to 2014.
RESULTS
One hundred and fifty-nine intermediate uveitis, posterior uveitis, and panuveitis patients (237 eyes) were identified. The patient population was 54.72% female; 67.30% of patients were Caucasian, and 22.01% were African-American. Mean age at diagnosis was 45.5 years. Mean duration of follow-up was 3.95 years. Mean number of visits to the clinic was 10.35. Of 491 uveitis patients, 26 (5.30%) had intermediate uveitis, 62 (12.60%) had posterior uveitis, and 71 (14.50%) had panuveitis. The leading diagnoses in the intermediate uveitis group were pars planitis (73.08%) and sarcoidosis (11.54%); toxoplasma uveitis (17.74%), multifocal choroiditis (14.52%), undifferentiated posterior uveitis (14.52%), and birdshot chorioretinitis (11.29%) in the posterior uveitis group; and undifferentiated panuveitis (29.58%), post-surgical panuveitis (18.31%), sarcoidosis (12.68%), acute retinal necrosis (12.68%), and toxoplasma uveitis (4.23%) in the panuveitis group. The most common treatment modalities included local steroids (57.23%) and systemic steroids (42.14%). Ocular hypertension was found in 38 patients (23.90%). Glaucoma surgery was performed in 18.24% of patients and cataract surgery in 21.38%. Mean best-corrected visual acuity was 0.66 logMAR at baseline across all anatomical locations and 0.57 logMAR at final follow-up. Best-corrected visual acuity improved or remained stable during follow-up in all groups.
CONCLUSION
The most common diagnoses in our series by anatomical location were pars planitis (intermediate uveitis), toxoplasmosis (posterior uveitis), and undifferentiated uveitis (panuveitis). Panuveitis had significantly worse visual outcomes and higher rates of complications than did intermediate or posterior uveitis, a finding that confirms earlier reports. In this series, unilateral disease, regardless of anatomical location, was associated with poorer visual outcome, in contrast with the findings of other reports.
PubMed: 26345421
DOI: 10.2147/OPTH.S89428 -
International Ophthalmology Jun 2021To report the epidemiology, etiology, ocular characteristics, management, and visual outcomes of pediatric uveitis patients in Southern Turkey.
PURPOSE
To report the epidemiology, etiology, ocular characteristics, management, and visual outcomes of pediatric uveitis patients in Southern Turkey.
METHODS
The clinical records of pediatric patients with a diagnosis of uveitis under the age of 16 years and followed up longer than 6 months were analyzed retrospectively.
RESULTS
The study included 102 patients and 173 affected eyes. The mean age at presentation was 11.4 ± 3.7 years. Uveitis was predominantly bilateral (69.6%), anterior (45.1%), and chronic (58.8%). The leading diagnoses were idiopathic uveitis (38.2%), pars planitis (19.6%), and juvenile idiopathic arthritis-associated uveitis (14.7%). Infectious uveitis accounted for 12.7%, and toxoplasmosis was the most common cause (10.8%). At least one complication was observed in 76.3% of the eyes, and optic disk edema (37%) was the most frequent. Corticosteroids were used in 97.1% and systemic immunomodulatory agents in 49% of the patients. Ocular surgery was performed in 17.3% of the eyes, and cataract extraction was the most common (8.7%). The mean BCVA was 0.39 ± 0.66 LogMAR at baseline and 0.25 ± 0.53 LogMAR at the last recorded visit.
CONCLUSION
Pediatric uveitis is a challenging disease that requires meticulous management. Anterior uveitis is the most frequent form. Despite a changing trend for an increase in diagnostic variety, idiopathic cases still constitute the majority. A significant number of patients receive systemic therapy, develop complications, and require surgical intervention. Early diagnosis and appropriate treatment might improve visual outcomes and reduce the risk of visual loss.
Topics: Adolescent; Child; Humans; Retrospective Studies; Tertiary Care Centers; Turkey; Uveitis; Visual Acuity
PubMed: 33624176
DOI: 10.1007/s10792-021-01764-7 -
Journal of Glaucoma Sep 2016To evaluate the efficacy and safety of trabeculotomy in the treatment of pediatric uveitic glaucoma (UG).
PURPOSE
To evaluate the efficacy and safety of trabeculotomy in the treatment of pediatric uveitic glaucoma (UG).
MATERIALS AND METHODS
We retrospectively reviewed all cases that underwent trabeculotomy for pediatric UG at our center between 2008 and 2014. Up to 2 trabeculotomies per eye were performed in patients with medically controlled uveitis. Surgical success was defined as final intraocular pressure <22 mm Hg and ≥6 mm Hg after 1 or 2 trabeculotomies, with or without medications. Kaplan-Meier survival analyses were done.
RESULTS
A total of 33 trabeculotomies were performed in 28 eyes of 22 patients. Diagnoses included UG associated with juvenile idiopathic arthritis (68.2%), idiopathic uveitis (22.7%), and pars planitis (9.1%). The average age at surgery was 9.8±3.7 (5 to 17) years. With a mean follow-up of 33.6±18.3 (10 to 78) months, the overall surgical success was 81.8%. The cumulative survival probability after up to 2 trabeculotomies was 0.86 (95% confidence interval, 0.71-0.93) at 12 months and 0.77 (95% confidence interval, 0.60-0.87) at 24 months. Four (11.5%) eyes required a second trabeculotomy to achieve surgical success and 4 (7.7%) required filtrating procedures. Intraocular pressure improved from 31.4±7.6 (18 to 50) mm Hg preoperatively to 15.0±3.6 (8 to 23) mm Hg at final visits, whereas the number of glaucoma medications decreased from 4.2±1.1 (1 to 5) to 0.4±1.0 (0 to 4). Visual acuity and intraocular inflammation remained stable (P>0.05) and there were no major complications.
CONCLUSIONS
Trabeculotomy is a safe and effective surgery for pediatric UG.
Topics: Adolescent; Child; Child, Preschool; Female; Glaucoma; Humans; Intraocular Pressure; Male; Retrospective Studies; Trabeculectomy; Uveitis, Anterior; Visual Acuity
PubMed: 27552504
DOI: 10.1097/IJG.0000000000000516 -
European Journal of Ophthalmology May 2022To report a case of a Hispanic girl with late-onset Retinoblastoma (Rb) who was misdiagnosed as a pars planitis prior to referral. Nearly 95% of all Rb cases are...
INTRODUCTION
To report a case of a Hispanic girl with late-onset Retinoblastoma (Rb) who was misdiagnosed as a pars planitis prior to referral. Nearly 95% of all Rb cases are detected before age 5, and this patient was 8 years-old.
METHODS
Case report of a late-onset Retinoblastoma with anterior chamber (AC) involvement plus the presence of an Ahmed valve. The patient had a history of a couple of months of topical therapy comprising medication for glaucoma, systemic steroids, and a filtration surgery (Ahmed valve), after that a biopsy was performed prior to referral. Upon arrival at our clinic, we performed an examination under anesthesia (EUA) and a B-scan ultrasound (US).
RESULTS
Unilateral Retinoblastoma with an Ahmed valve in an AC filled with Rb seeds was diagnosed with the EUA and US in the left eye. An orbital exenteration with map biopsies of the left orbital cavity was performed with confirmation by histopathology of a poorly differentiated endophytic retinoblastoma with Bruch's membrane invasion. Follow-up sessions were then arranged as well as subsequent systemic chemotherapy cycles.
CONCLUSION
Given the rare incidence of retinoblastoma in children older than 5 years old, it can be easily mistaken for other differential diagnoses and treated with filtration surgeries that could put the patient's life at risk. In this report, late-onset Rb diagnosis is highlighted as a differential diagnosis in children and adults with atypical uveitis, which required a multidisciplinary approach.
Topics: Anterior Chamber; Child; Child, Preschool; Female; Hispanic or Latino; Humans; Pars Planitis; Retinal Neoplasms; Retinoblastoma; Retrospective Studies; Uveitis, Intermediate
PubMed: 33567900
DOI: 10.1177/1120672121994487 -
Turkish Journal of Ophthalmology Apr 2024We report the visual and clinical outcomes of a middle-aged woman who presented with exudative retinal detachment (ERD) secondary to a vasoproliferative tumor (VPT) in...
We report the visual and clinical outcomes of a middle-aged woman who presented with exudative retinal detachment (ERD) secondary to a vasoproliferative tumor (VPT) in an eye with sarcoidosis-associated intermediate uveitis. A 55-year-old woman previously diagnosed with sarcoidosis presented with decreased vision in the left eye (LE). Visual acuity in the LE was counting fingers. She had active vitritis, and a peripheral retinal vascular mass was noted in the superotemporal periphery. The mass was associated with ERD involving the posterior pole. The patient was managed with systemic and intravitreal steroids, and cyclosporine was subsequently added as a steroid-sparing agent. Because of recurrence of ERD, the patient underwent pars plana vitrectomy, and cryotherapy and laser photocoagulation were applied to the VPT. Two months postoperatively, visual acuity in the LE improved to 6/10. There was marked regression of the VPT and total resolution of the ERD. In conclusion, we report a favorable visual and clinical outcome in a patient with VPT-associated ERD who responded to a combination of medical therapy and surgical intervention. VPT may lead to different remote complications, so timely diagnosis of these tumors and proper management of their complications is warranted.
Topics: Humans; Female; Middle Aged; Sarcoidosis; Visual Acuity; Fluorescein Angiography; Retinal Neoplasms; Uveitis, Intermediate; Tomography, Optical Coherence; Fundus Oculi; Vitrectomy; Glucocorticoids; Retinal Detachment
PubMed: 38645965
DOI: 10.4274/tjo.galenos.2024.36926 -
Middle East African Journal of... 2014To determine the etiologies of uveitis and the causes of visual loss in uveitis patients at a referral center in Baghdad, Iraq.
PURPOSE
To determine the etiologies of uveitis and the causes of visual loss in uveitis patients at a referral center in Baghdad, Iraq.
PATIENTS AND METHODS
A 4-year prospective study was performed at the uveitis clinic at Ibn Al-Haetham teaching eye hospital in Baghdad, Iraq. Referral cases of active uveitis were included. A complete ophthalmic examination was performed in all cases. If clinical picture did not indicate a specific etiology, patients were sent for a routine set of tests while ancillary tests were conducted when indicated.
RESULTS
Out of 318 patients included in this study, 236 patients (74.2%) had bilateral uveitis, and 212 patients (66.7%) had non-granulomatous uveitis. Posterior uveitis was recorded in 123 cases (38.7%) followed by panuveitis in 97 cases (30.5%), anterior uveitis in 78 cases (24.5%), and intermediate uveitis in 20 cases (6.3%). A diagnosis was established in 210 cases (66%) while etiology could not be determined in the remaining 108 cases (34%). Most common infectious causes were toxoplasmosis (13.8%) and presumed ocular tuberculosis (11.4%) while most common non-infectious causes were Vogt-Koyanagi-Harada disease (12.3%), Behηet's disease (8.2%), and pars planitis (5.7%). Out of 49 eyes with irreversible blindness, macular degenerations, or scars (46.9%) and optic nerve atrophy (34.7%) were the most important causes.
CONCLUSION
At this referral center, toxoplasmosis and presumed ocular tuberculosis were the most common infectious causes of uveitis while Vogt-Koyanagi-Harada disease, Behηet's disease, and pars planitis were, in that order, the most common non-infectious causes. Macular degenerations or scars and optic nerve atrophy were the most important causes of irreversible blindness.
Topics: Acute Disease; Adult; Chronic Disease; Female; Humans; Iraq; Male; Middle Aged; Prospective Studies; Referral and Consultation; Uveitis; Young Adult
PubMed: 25371632
DOI: 10.4103/0974-9233.142263 -
Indian Journal of Ophthalmology Mar 2017Ophthalmia nodosa with vitreoretinal involvement is rare and may cause permanent loss of eye due to persistent inflammation of the eye. A young female patient having...
Ophthalmia nodosa with vitreoretinal involvement is rare and may cause permanent loss of eye due to persistent inflammation of the eye. A young female patient having multiple caterpillar hair in the eye including cornea, anterior chamber, sclera, and pars plana presented with recurrent vitritis and pars planitis. Ultrasound biomicroscopy played a vital role and helped in localizing the hair embedded in the pars plana region which were managed by pars plana vitrectomy leading to complete recovery.
Topics: Anterior Chamber; Eye Foreign Bodies; Female; Hair; Humans; Microscopy, Acoustic; Vitrectomy; Young Adult
PubMed: 28440257
DOI: 10.4103/ijo.IJO_985_15