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Arthritis Care & Research Nov 2020Chronic uveitis is a common manifestation of pediatric rheumatologic conditions and may result in irreversible blindness and long-term disability. While chronic anterior...
OBJECTIVE
Chronic uveitis is a common manifestation of pediatric rheumatologic conditions and may result in irreversible blindness and long-term disability. While chronic anterior uveitis is the most commonly encountered ocular manifestation of rheumatic disease, little is known about the clinical presentation, management, and long-term outcome of more complex eye conditions such as pars planitis (PP), panuveitis (PU), and Vogt-Koyanagi-Harada disease (VKH). The present study was undertaken to comprehensively assess the long-term safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and biologics for the treatment of pediatric and adolescent patients with PP, PU, and VKH.
METHODS
We retrospectively reviewed a cohort of 75 children and adolescents with idiopathic PP (n = 50), PU (n = 12), and VKH (n = 14) followed by the Pediatric Rheumatology Core at Children's Hospital Los Angeles and evaluated referral patterns, clinical presentation, treatment response, and long-term clinical outcome.
RESULTS
Patients were followed for an average of 52 months. Their mean age at disease onset was 10 years. Bilateral eye involvement was seen in 87% of the patients. At first presentation to an ophthalmologist, glaucoma was noted in 21% of patients and vision loss (<20/40) in 87% of patients, while legal blindness (≤20/200 in the better-seeing eye) was diagnosed in 18 of 75 (24%) of patients (PP 22%, PU 36%, and VKH 21%). The average referral time to a pediatric rheumatologist was 13 months (range 1-96 months). Topical steroids were used in all patients, but 98% of patients required additional DMARDs, and 73% required therapy with biologics. After a mean of 52 months, 35% of patients across all disease groups had significant vision loss or were blind, and only 28% were in clinical remission without medications. The worst outcome was observed in children with PU. Regression analysis, young age at onset, delayed referral to a pediatric rheumatologist, and chronic disease were strong predictors for the risk of long-term blindness.
CONCLUSION
PP, PU, and VKH involve a high risk of permanent vision loss and should be managed by a skilled rheumatologist as early and as aggressively as possible.
Topics: Adolescent; Antirheumatic Agents; Biological Products; Child; Female; Humans; Male; Panuveitis; Pars Planitis; Regression Analysis; Retrospective Studies; Uveomeningoencephalitic Syndrome; Vision Disorders
PubMed: 31444859
DOI: 10.1002/acr.24056 -
Journal of Ophthalmic Inflammation and... Jun 2011To report a case of corneal ectasia secondary to pars planitis corneal endotheliopathy
PURPOSE
To report a case of corneal ectasia secondary to pars planitis corneal endotheliopathy
METHODS
Clinical case description and proposed hypothesis regarding development of corneal ectasia
RESULTS
Eight-year-old male presented with 360° peripheral corneal endotheliopathy and edema, granulomatous keratic precipitates, and mild iritis OD. A progressive corneal ectasia then developed. Twenty months later, OS presented similarly and anterior chamber inflammatory cells, vitreous snowballs, and retinal vasculitis were observed OU. Classic pars planitis was diagnosed
CONCLUSION
This is the first case of endotheliopathy as the first manifestation of pars planitis and as a cause of a secondary central cornea ectasia developed.
PubMed: 21484170
DOI: 10.1007/s12348-010-0005-7 -
Archivos de La Sociedad Espanola de... Aug 2013Pars planitis is an intermediate uveitis with bilateral and asymmetric presentation. The etiology is unknown and pathogenesis is unclear. Treatment follows the algorithm... (Observational Study)
Observational Study
INTRODUCTION
Pars planitis is an intermediate uveitis with bilateral and asymmetric presentation. The etiology is unknown and pathogenesis is unclear. Treatment follows the algorithm of Foster, which includes selective photocoagulation. The mechanism of action of photocoagulation is still unknown.
MATERIAL AND METHODS
An observational, longitudinal, ambispective cohort study was performed with the objective of evaluating the course of inflammation in patients with pars planitis treated with a selective argon laser.
RESULTS
The study included 29 patients (10 female and 19 male) diagnosed with pars planitis and were treated with selective laser. The mean age of onset was 11.77 years. Eighteen (62.1%) patients were not immunosuppressed at the time of receiving the selective laser, and 11 (37.9%) were taking immunosuppressants. Indications for selective laser were; following the algorithm, 19 (65.55%), vitreous hemorrhage 7 (24.1%), vitrectomy 2 (6.98%), and neovascularization 1 (3.4%). The mean time for inflammation reduction was 5.9 months, and 17 patients (58.6%) had no relapse. Visual acuity showed improvement post-laser (OD P=.025 and OI P=.022). There was also an improvement in vitreous cells.
CONCLUSION
Selective laser was effective in 58.6%% of patients.
Topics: Adolescent; Algorithms; Child; Female; Humans; Light Coagulation; Longitudinal Studies; Male; Pars Planitis; Prospective Studies; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 23886360
DOI: 10.1016/j.oftal.2012.09.032 -
Bulletin de La Societe Belge... 1983
Topics: Adult; Ciliary Body; Female; Humans; Night Blindness; Prednisone; Retinal Degeneration; Uveitis
PubMed: 6333906
DOI: No ID Found -
Journal of Cataract and Refractive... Oct 2004To analyze the results of phacoemulsification cataract surgery with implantation of posterior chamber intraocular lenses (IOLs) of different biomaterials in eyes with...
PURPOSE
To analyze the results of phacoemulsification cataract surgery with implantation of posterior chamber intraocular lenses (IOLs) of different biomaterials in eyes with pars planitis.
SETTING
Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India.
METHODS
The records of 86 patients (100 eyes) with pars planitis who had phacoemulsification with IOL implantation between January 1997 and April 2003 were retrospectively analyzed. The eyes were divided into 3 groups depending on IOL biomaterial: poly(methyl methacrylate) (PMMA) (n=32), heparin-surface-modified PMMA (n=39), or acrylic (n=29). The postoperative visual outcome and complications in each group were analyzed.
RESULTS
Forty-seven patients were men and 39, women. The mean age was 38 years (range 10 to 65 years) and the mean follow-up, 19.67 months (range 3.00 to 54.53 months). At the final follow-up, 91 eyes (91%) had better visual acuity than preoperatively; 79 had an improvement of 2 or more Snellen lines, 12 had an improvement of 1 Snellen line, 4 had no change, and 5 had a decrease as a result of reactivation of the pars planitis and progression of cystoid macular edema (CME). Significant posterior capsule opacification occurred in 10 eyes (10%), CME in 50 eyes (50%), reactivation of pars planitis in 51 eyes (51%), IOL deposits in 29 eyes (29%), IOL decentration in 1 eye (1%), and anterior capsule fibrosis in 14 eyes (14%). The most frequent cause of poor visual recovery was CME, submacular fibrosis, and epiretinal membrane. There was no statistically significant difference in these complications between the 3 groups.
CONCLUSIONS
Phacoemulsification with IOL implantation in eyes with pars planitis was safe and led to good visual outcomes in most cases. The factors in surgical success were control of inflammation, meticulous surgery, in-the-bag IOL implantation, and vigilant postoperative care.
Topics: Acrylic Resins; Adolescent; Adult; Aged; Child; Coated Materials, Biocompatible; Female; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Male; Middle Aged; Pars Planitis; Phacoemulsification; Polymethyl Methacrylate; Postoperative Complications; Retrospective Studies; Safety; Visual Acuity
PubMed: 15474816
DOI: 10.1016/j.jcrs.2004.02.090 -
Ophthalmologica. Journal International... 1991Cryotherapy was performed on 28 eyes exhibiting massive exudates (snowbank) over the pars plana and the ora serrata. Twenty-six patients ranging in age from 8 to 52...
Cryotherapy was performed on 28 eyes exhibiting massive exudates (snowbank) over the pars plana and the ora serrata. Twenty-six patients ranging in age from 8 to 52 years were treated and then followed up for a median of 34 months. Eleven eyes needed repeat cryotherapy. After cryotherapy, retinal vasculitis and vitreous opacities decreased in most eyes. Although only 3 of 5 eyes with a snowbank greater than 90 degrees and treated over 1 year from the onset achieved visual acuity of 20/25 or better, all 12 eyes with a snowbank smaller than 60 degrees and treated within 3 months after the onset maintained a visual acuity of 20/25 or better. The prognosis was not different from the 20 eyes that received systemic steroid treatment and the 8 eyes that received no systemic steroids. We recommend cryotherapy as the primary treatment for pars planitis with a snowbank.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; Child; Combined Modality Therapy; Cryosurgery; Female; Follow-Up Studies; Humans; Male; Middle Aged; Ophthalmoscopy; Pars Planitis; Postoperative Complications; Reoperation; Visual Acuity
PubMed: 1945296
DOI: 10.1159/000310192 -
Canadian Journal of Ophthalmology.... Oct 1991Cryotherapy has been reported to be of benefit in pars planitis. We studied 16 eyes with classic pars planitis unresponsive to corticosteroid therapy. Eight eyes... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Cryotherapy has been reported to be of benefit in pars planitis. We studied 16 eyes with classic pars planitis unresponsive to corticosteroid therapy. Eight eyes continued with systemic and periocular steroid therapy, and in the remaining eight eyes transconjunctival cryopexy of the peripheral retina and vitreous base was done as an additional procedure. At 6 months four of the eyes that received cryopexy showed an improvement in Snellen visual acuity, and in the other four the acuity was unchanged; none of the eyes showed any vitreous base neovascularization. Among the eyes that received steroid therapy only, the acuity was unchanged in five, improved in one and reduced in two.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; Cryosurgery; Female; Follow-Up Studies; Humans; Male; Pars Planitis; Prospective Studies; Random Allocation; Treatment Outcome; Visual Acuity
PubMed: 1751913
DOI: No ID Found -
American Journal of Ophthalmology Apr 1981We studied 13 patients, six males and seven females, ranging in age from 14 to 53 years, with chronic pars planitis and a form of secondary retinal degeneration. All had...
We studied 13 patients, six males and seven females, ranging in age from 14 to 53 years, with chronic pars planitis and a form of secondary retinal degeneration. All had experienced visual blurring but none had significant pain. Nine of the 13 had some disturbance in night vision. Visual acuity had decreased in three patients (in one because of cataract, in one because of cystoid macular degeneration, and for unknown reasons in the third), increased in two patients (because of improvement in cystoid macular edema), and remained stable in eight. There were electrophysiologic abnormalities, consisting of delayed B-wave implicit time, abnormal response to 30-Hz flicker, and reduced B-wave oscillations, in almost every patient. Our finding suggested that pars planitis is a vitreoretinal disorder rather than an inflammatory disease of the uveal tract.
Topics: Adolescent; Adult; Chronic Disease; Electrophysiology; Electroretinography; Female; Humans; Male; Middle Aged; Retinal Degeneration; Uveitis
PubMed: 7223823
DOI: 10.1016/0002-9394(81)90241-5 -
Ocular Immunology and Inflammation Jun 2004To describe the clinical characteristics and course of 16 patients with uveitis associated with multiple sclerosis (MS).
BACKGROUND/AIMS
To describe the clinical characteristics and course of 16 patients with uveitis associated with multiple sclerosis (MS).
METHODS
The records of 1254 patients with uveitis were reviewed. Sixteen of these patients had MS. The history, review of systems, ocular findings, and clinical test results of each of these 16 subjects were analyzed. The mean follow-up time was 38 months.
RESULTS
Most patients with MS-associated uveitis were white females between 20 and 50 years of age. The diagnosis of MS preceded the onset of uveitis in 56%, followed it in 25%, and was made concurrently in 19% of the cases. In 94%, the uveitis was bilateral. Pars planitis was the most frequent form of uveitis in our study population (81%); concomitant anterior chamber inflammation was common and was granulomatous in nature 56% of the time. Forty-one percent of the eyes with MS-associated uveitis had 20/30 or better initial visual acuity. Among these treated patients, significant loss of visual acuity was uncommon.
CONCLUSIONS
MS-associated uveitis should be suspected in white female patients with bilateral uveitis, especially if pars planitis is present. These patients often retain useful vision for many years if treated.
Topics: Adult; Anterior Chamber; Female; Follow-Up Studies; Humans; Inflammation; Male; Middle Aged; Multiple Sclerosis; Pars Planitis; Uveitis; Visual Acuity
PubMed: 15512983
DOI: 10.1080/09273940490895344 -
Archives of Ophthalmology (Chicago,... Apr 1980Vitreous cylinders, a rarely discussed ophthalmologic entity, were studied in two clinical cases and in five enucleated eyes. The cylinders were found in four cases of...
Vitreous cylinders, a rarely discussed ophthalmologic entity, were studied in two clinical cases and in five enucleated eyes. The cylinders were found in four cases of ocular toxoplasmosis, one case of vitreous hemorrhage complicating a malignant melanoma, and one case of pars planitis and one of uveitis, both of unknown causes. Results of scanning electron microscopy in one specimen suggested that cylinders are formed by condensation of vitreous collagen fibers. We emphasize the nonspecific nature of this interesting vitreous finding.
Topics: Aged; Child; Eye Diseases; Eye Neoplasms; Female; Humans; Male; Melanoma; Microscopy, Electron, Scanning; Middle Aged; Retina; Toxoplasmosis, Ocular; Uveal Diseases; Uveitis; Vitreous Body
PubMed: 7369912
DOI: 10.1001/archopht.1980.01020030728018