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Journal of Ophthalmic & Vision Research Oct 2011Uveitis is less common in children than in adults, and its diagnosis and management can be particularly challenging. Young children are often asymptomatic either because...
Uveitis is less common in children than in adults, and its diagnosis and management can be particularly challenging. Young children are often asymptomatic either because of inability to express complaints or because of the truly asymptomatic nature of their disease. Even in advanced cases, parents may not be aware of severe visual impairment until the development of externally visible changes such as band keratopathy, strabismus, or leukocoria. Therefore, the diagnosis is often delayed and severe complications may be seen at the time of initial visit. Young children may not be cooperative for a complete ocular examination and subtle findings of intraocular inflammation such as trace cells may be easily missed in the early stages of the disease. Children, in general, tend to have more severe and chronic intraocular inflammation that frequently results in ocular complications and visual loss. In children who present with amblyopia or strabismus, a careful examination is required to rule out uveitis as an underlying cause. Delayed and variable presentations cause a distinct challenge in the diagnosis of uveitis in children, furthermore differential diagnosis also requires awareness of etiologies which are different from adults. There are unique forms of uveitis and masquerade syndromes in this age group, while some entities commonly encountered in adults are rare in children.
PubMed: 22454749
DOI: No ID Found -
Ocular Immunology and Inflammation May 2024To evaluate outcomes of intravenous (IV) tocilizumab (TCZ) in patients with pars planitis refractory to conventional immunomodulatory therapy and anti-tumor necrosis...
PURPOSE
To evaluate outcomes of intravenous (IV) tocilizumab (TCZ) in patients with pars planitis refractory to conventional immunomodulatory therapy and anti-tumor necrosis factor (TNF) alpha agents.
METHODS
Medical records of eight patients diagnosed with pars planitis and treated with monthly 4 or 8 mg/kg IV TCZ were reviewed. The primary objective was to initiate and sustain remission continuously for three consecutive months. Secondary outcome measures were changes in best corrected visual acuity (BCVA), degree of anterior chamber (AC) inflammation, vitreous cell, vitreous haze, presence of vitreous or pars plana exudates, peripheral vasculitis, fluorescein angiography (FA) score and central subfieldthickness (CST) on macular optical coherence tomography (OCT).
RESULTS
Fourteen eyes of eight patients were treated with IV TCZ. Seven patients were women. The average age was 31.35 ± 16.42 years. In 6 (75%) out of 8 patients, IV TCZ, either as monotherapy or in combination with another conventional immunomodulatory agent, induced and sustained remission. The average FA score reduced from 11.15 ± 3.52 at the baseline visit to 6.50 ± 2.12 at the one-year follow-up visit (p-value < 0.05). None of the patients experienced any side effects of IV TCZ.
CONCLUSION
IV Tocilizumab (TCZ) may represent an effective and safe treatment option for patients diagnosed with pars planitis resistant to conventional immunomodulatory therapy and anti-TNF alpha agents.
PubMed: 38781578
DOI: 10.1080/09273948.2024.2354751 -
American Journal of Ophthalmology Dec 1978Seven eyes and one vitrectomy specimen from seven patients with pars planitis and complications such as secondary glaucoma and phthisis bulbi were studied...
Seven eyes and one vitrectomy specimen from seven patients with pars planitis and complications such as secondary glaucoma and phthisis bulbi were studied histopathologically. Two of the specimens were also examined by electron microscopy. All cases showed a typical intravitreal "snowbank" opacity overlying the pars plana. On light microscopy, these "snowbanks" appeared to consist of a loose fibrovascular layer containing occasional fibrocyte-like cells and scattered mononuclear inflammatory cells adjacent to the hyperplastic nonpigmented epithelium of the pars plana. Within the vitreous base, an extensive fibroglial proliferation had developed, often drawing the peripheral retina anteriorly into the "snowbank." Electron microscopy showed this fibroglial tissue to be composed of condensed vitreous collagen and probable fibrous astrocytes which had produced larger-diameter (about 24 mm) collagen fibrils. The fibroglial proliferation also appeared continuous with an ultrastructurally similar preretinal fibroglial membrane. All eyes showed prominent lymphocytic cuffing and mural infiltration of retinal veins, with sparing of the arterioles. Several cases showed cystoid macular edema. Only mild choroiditis or cyclitis could be shown in some cases. We believe that in pars planitis the fibroglial "snowbank" may reflect a common inflammatory process involving both the peripheral retina and vitreous base.
Topics: Adolescent; Adult; Astrocytes; Child; Chorioretinitis; Ciliary Body; Cytoplasm; Epithelium; Eye Diseases; Female; Glaucoma; Humans; Lymphocytes; Male; Middle Aged; Retina; Uveitis; Uveitis, Anterior; Vitreous Body
PubMed: 569977
DOI: 10.1016/0002-9394(78)90118-6 -
Journal of Ophthalmic Inflammation and... Jan 2013Choroidal neovascularization (CNV) is a rare complication of intermediate uveitis. Risk factors are not well-characterized. Here, we describe a case of peripapillary CNV...
BACKGROUND
Choroidal neovascularization (CNV) is a rare complication of intermediate uveitis. Risk factors are not well-characterized. Here, we describe a case of peripapillary CNV in a patient with intermediate uveitis and explore the pathophysiology and treatment of this condition. This study is a case report and review of the literature.
RESULTS
A 15-year-old boy with intermediate uveitis - suppressed for the preceding year on immunosuppressive therapy and low-dose corticosteroids - and chronic disc swelling presented with unilateral metamorphopsia, peripapillary subretinal hemorrhage, and subretinal fluid. Fluorescein angiogram confirmed the presence of an active choroidal neovascular membrane. Treatment with intravitreal bevacizumab 1.25 mg every 4 weeks for 4 months resulted in resolution of subretinal fluid, subretinal hemorrhage, and regression of the CNV. The patient's intermediate uveitis remained inactive throughout this time.
CONCLUSION
Review of the existing literature and pathophysiologic consideration suggests that chronic disc edema may be a risk factor for this condition. Peripapillary CNV in the context of intermediate uveitis appears to respond well to VEGF-inhibitor therapy.
PubMed: 23514324
DOI: 10.1186/1869-5760-3-13 -
International Ophthalmology Jan 2023To evaluate the effectiveness and safety of anti-tumor necrosis factor-alpha (anti-TNF-alpha) treatment (Adalimumab [ADA]) combined with immunomodulatory agents (IMAs)...
AIM
To evaluate the effectiveness and safety of anti-tumor necrosis factor-alpha (anti-TNF-alpha) treatment (Adalimumab [ADA]) combined with immunomodulatory agents (IMAs) in the treatment of pars planitis (PP).
METHODS
The patients with PP who were treated with anti-TNF-alpha agents for at least six months were qualified for the chart review. The outcome parameters were the steroid-free remission state, the best-corrected visual acuity (BCVA) and the central macular thickness (CMT) of the patients at the last visit.
RESULTS
After a mean total follow-up time of 15.5 ± 5.8 months (8-24 months), all the cases were in steroid-free remission at the last visit. The mean BCVA increased, and the mean CMT decreased significantly at the last visit (p < 0.001, p < 0.001, respectively).
CONCLUSION
ADA combined with IMAs offers effective and safe treatment modalities in the control of chronic intraocular inflammation in PP cases.
Topics: Child; Humans; Adalimumab; Inflammation; Necrosis; Pars Planitis; Retrospective Studies; Treatment Outcome; Tumor Necrosis Factor Inhibitors; Turkey
PubMed: 35780435
DOI: 10.1007/s10792-022-02398-z -
Journal of Ophthalmic Inflammation and... Feb 2023We describe a case report of pediatric pars planitis complicated with massive exudative retinal detachment (ERD). A 7-year-old presented with visual acuity (VA) in the...
We describe a case report of pediatric pars planitis complicated with massive exudative retinal detachment (ERD). A 7-year-old presented with visual acuity (VA) in the right eye (RE) of 6/9 and in the left eye (LE) 6/15. Fundoscopy revealed BE inferior retinoschisis, vitritis and snowballs. He was treated with systemic immunosuppressants. RE retinoschisis resolved within 2 months. Three years later presented with LE VA 6/60 and total ERD. Systemic and intravitreal steroids were administered. Due to refractoriness, he underwent 360° scleral buckle and drainage of subretinal fluid. No retinal breaks or traction were detected. Five months postoperatively LE VA was 6/7.5. Long-term stable outcome was maintained. We report a challenging total ERD as a complication of pars planitis. Although extensive and non-responsive to medical therapy, complete resolution and improvement in vision was achieved with surgical intervention and systemic immunosuppression. We speculate that uncontrolled chronic vasculitic process culminated in diffuse ERD.
PubMed: 36849851
DOI: 10.1186/s12348-023-00328-3 -
International Ophthalmology Apr 2018To evaluate the demographic characteristics, clinical features, treatment and outcomes of patients with pars planitis in a tertiary referral center in Turkey.
PURPOSE
To evaluate the demographic characteristics, clinical features, treatment and outcomes of patients with pars planitis in a tertiary referral center in Turkey.
METHODS
Medical records of patients with pars planitis were retrospectively reviewed. The data including demographic and ocular features and treatment outcomes were recorded. The distribution of clinical findings and complications were evaluated according to age and gender groups. The changes in final BCVA compared to the initial BCVA were noted. Statistical analysis was performed using SPSS software (Version 18.0, SPSS Inc., Chicago, USA).
RESULTS
Twenty-seven patients (54 eyes) were included in this study. 16 patients were male (59.3%), and 11 were female (40.7%). Mean age at diagnosis was 12.84 ± 8.26 (range 4-36) years. Mean follow-up period was 61.3 ± 52.15 (range 9-172) months. Mean BCVA was 0.58 ± 0.36 (range 0.03-1.00) (0.40 ± 0.45 logMAR) at presentation, and 0.81 ± 0.28 (range 0.10-1.00) (0.14 ± 0.27 logMAR) at final visit (P = 0.001). Vitreous inflammation (100%), vitreous haze (92.6%), snowballs (74.1%), snowbanks (66.7%), anterior chamber cells (66.7%) and peripheral retinal vascular sheathing (48.1%) were the most common presentations. Ocular complications included vitreous condensation (51.9%), cystoid macular edema (22.2%), cataract (18.5%), inferior peripheral retinal detachment (11.1%), glaucoma (5.6%) and vitreous hemorrhage (3.7%). Treatments included topical, periocular, intravitreal and systemic corticosteroids, immunosuppressives, peripheral laser photocoagulation and pars plana vitrectomy when needed.
CONCLUSIONS
Pars planitis is an idiopathic chronic intermediate uveitis mostly affecting children and adolescents. In spite of its chronic nature with high potential of causing ocular complications, adequate treatment and close follow-up lead to favorable visual outcomes.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; Age Factors; Child; Child, Preschool; Female; Humans; Immunosuppressive Agents; Laser Coagulation; Male; Pars Planitis; Retrospective Studies; Sex Factors; Turkey; Visual Acuity; Vitrectomy; Vitreous Body; Young Adult
PubMed: 28389773
DOI: 10.1007/s10792-017-0526-2 -
American Journal of Ophthalmology May 1987We divided 61 patients (111 eyes) with pars planitis into three groups based on clinical appearance. Patients in Group I had bilateral vitreous cells and bilateral pars...
We divided 61 patients (111 eyes) with pars planitis into three groups based on clinical appearance. Patients in Group I had bilateral vitreous cells and bilateral pars plana exudates (36 patients, 72 eyes); patients in Group II had bilateral vitreous cells but a pars plana exudate in one eye only (14 patients, 28 eyes); and patients in Group III had vitreous cells and exudate formation in the single eye involved (11 patients, 11 eyes). The presence of a pars plana exudate was associated with more severe vitreous disease and increased incidence of cystoid macular edema.
Topics: Adult; Ciliary Body; Exudates and Transudates; Humans; Macular Edema; Uveitis; Vitreous Body
PubMed: 3578463
DOI: 10.1016/s0002-9394(14)74327-2 -
Ophthalmology Jun 1999To evaluate the results of pars plana vitrectomy and membrane stripping for visually significant macular epiretinal membranes associated with chronic idiopathic pars...
OBJECTIVE
To evaluate the results of pars plana vitrectomy and membrane stripping for visually significant macular epiretinal membranes associated with chronic idiopathic pars planitis.
DESIGN
Consecutive noncomparative case series.
PARTICIPANTS AND METHODS
The records of all patients who underwent pars plana vitrectomy for pars planitis from 1988 through 1997 were retrospectively reviewed. Seven eyes of five patients who were diagnosed with visually significant epiretinal membranes associated with pars planitis and who underwent vitrectomy and membrane stripping were analyzed. Patients were diagnosed with pars planitis based on characteristic clinical signs and pertinent negative laboratory test results.
INTERVENTION
Pars plana vitrectomy and epiretinal membrane stripping.
MAIN OUTCOME MEASURES
Visual acuity and inflammatory grade were compared between the last preoperative visit and the most recent follow-up visit. Intraoperative and postoperative complications were also analyzed.
RESULTS
The mean patient age was 31 years (range, 6 to 45 years). The mean duration of uveitis was 6.4 years (range, 6 months to 13 years). All patients were treated with combinations of periocular, topical, and oral corticosteroids before surgery. Five eyes had laser retinopexy, and two eyes had cryopexy to the inferior retina at the time of surgery. Five eyes had at least 3 Snellen lines of visual acuity improvement, and visual acuity in one eye worsened by 2 lines. Mean preoperative visual acuity was 20/73 (range, 20/50 to 20/300), and mean final visual acuity was 20/37 (range, 20/25 to 20/70). Five eyes had a final visual acuity of 20/40. Vitritis improved in all cases. Mean follow-up was 23 months (range, 3 to 54 months). Six of seven eyes had progressive cataract development, four of which underwent cataract extraction. No other intraoperative or postoperative complications occurred.
CONCLUSIONS
Removal of epiretinal membranes associated with pars planitis can be safely performed and may result in improved visual acuity. Patients often require subsequent cataract extraction to obtain the best long-term final acuity.
Topics: Acute Disease; Adolescent; Adult; Child; Epiretinal Membrane; Female; Follow-Up Studies; Humans; Intraoperative Complications; Male; Middle Aged; Pars Planitis; Postoperative Complications; Retrospective Studies; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 10366075
DOI: 10.1016/S0161-6420(99)90247-6 -
Graefe's Archive For Clinical and... Jun 2022
Topics: Adalimumab; Humans; Multiple Sclerosis; Pars Planitis; Uveitis, Intermediate
PubMed: 35015113
DOI: 10.1007/s00417-021-05527-z