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Journal of AAPOS : the Official... Jun 2019To describe the use of infliximab after adalimumab failure in the treatment of pediatric noninfectious uveitis.
PURPOSE
To describe the use of infliximab after adalimumab failure in the treatment of pediatric noninfectious uveitis.
METHODS
A retrospective analysis was performed on the medical records of pediatric patients with noninfectious uveitis treated with infliximab for a minimum of 6 months after previously failing to achieve steroid-free remission using adalimumab at the University of Texas Medical School and Children's Medical Center between September 2015 and March 2018. Rates of achieving disease activity quiescence and steroid-free remission as well as incidence of adverse events were calculated.
RESULTS
A total of 13 patients with noninfectious uveitis refractory to treatment with adalimumab met inclusion criteria. Three (23%) had anterior uveitis, 4 (31%) had pars planitis, and 6 (46%) had panuveitis. Eleven (85%) patients had preexisting ocular comorbidities. Of these, 4 (31%) had retinal vasculitis, and 1 (7.7%) had cystoid macular edema. There was a 100% response rate to treatment with infliximab following failure to achieve disease quiescence on adalimumab. At mean follow-up time of 21 months (range, 8-31) from initiation of infliximab, there was a reduction in steroid dependence from 100% to 15% after transitioning from adalimumab to infliximab (P < 0.001). Nine patients (69%) had achieved steroid-free remission on infliximab therapy. The mean time to steroid-free remission was 8.7 months.
CONCLUSIONS
In our study cohort, infliximab was used successfully in all cases of recalcitrant pediatric noninfectious uveitis that previously failed adalimumab therapy.
Topics: Adalimumab; Adolescent; Antirheumatic Agents; Child; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Infliximab; Male; Retrospective Studies; Treatment Failure; Treatment Outcome; Uveitis, Intermediate
PubMed: 31063811
DOI: 10.1016/j.jaapos.2019.02.006 -
American Journal of Ophthalmology Jun 2019To investigate the clinical course and visual outcome of macular edema (ME) in pediatric patients with chronic noninfectious uveitis.
PURPOSE
To investigate the clinical course and visual outcome of macular edema (ME) in pediatric patients with chronic noninfectious uveitis.
DESIGN
Retrospective case series.
METHODS
The databases of the uveitis clinics of 4 tertiary medical centers in Israel and the UK were searched for all children treated for uveitic ME in the years 2005-2015. Data were collected from the medical records as follows: demographics, diagnosis, visual acuity, clinical and imaging findings, and treatment given specifically for ME. Findings at baseline and at 3, 6, 12, and 24 months were evaluated.
RESULTS
The cohort included 25 children (33 eyes) of mean age 8.5 ± 3.4 years. The most common diagnosis was intermediate uveitis, in 14 children (7 idiopathic, 7 pars planitis). Uveitis was active at ME diagnosis in 28 eyes (84.8%). Median duration of follow-up was 48 months. Median time to resolution of ME was 6 months, with complete resolution in 25 eyes (75.8%) by 24 months. Baseline visual acuity was ≥20/40 in 8 eyes (24.2%), increased to 57.6% at 3 months (P < .0001), and remained stable thereafter. Treatment regimens included corticosteroids (systemically and/or locally), immunosuppression, and biologic therapies. No correlation was found between outcome and either structural characteristics of ME or specific treatment strategy.
CONCLUSIONS
The prognosis of pediatric uveitic ME is favorable despite its chronic course. Larger randomized controlled trials are needed to define differences among treatment regimens.
Topics: Biological Factors; Child; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Glucocorticoids; Humans; Immunosuppressive Agents; Macula Lutea; Macular Edema; Male; Prognosis; Retrospective Studies; Tomography, Optical Coherence; Uveitis, Intermediate; Visual Acuity
PubMed: 30772346
DOI: 10.1016/j.ajo.2019.02.011 -
BMC Ophthalmology Sep 2018To report our findings in a young patient with unilateral retinitis pigmentosa (RP)-like appearance who developed pigmentary changes in his left retina after an episode...
BACKGROUND
To report our findings in a young patient with unilateral retinitis pigmentosa (RP)-like appearance who developed pigmentary changes in his left retina after an episode of bilateral pars planitis.
CASE PRESENTATION
A 17-year-old man presented with 6 months of blurry vision in both eyes. He was diagnosed with bilateral pars planitis. Progressive, intraretinal bone crepuscule pigmentation developed in his left retina during the following three months. An electroretinogram showed subnormal response only in the left eye, suggesting the diagnosis of unilateral pseudoRP.
CONCLUSION
An inflammatory disease like pars planitis can accelerate the pigmentation of the retina and mimic a RP in young patients. Causes of pseudoRP may be considered, especially in those rare cases with unilateral affection.
Topics: Adolescent; Diagnosis, Differential; Disease Progression; Electroretinography; Humans; Male; Pars Planitis; Pigmentation; Pigmentation Disorders; Retina; Retinal Diseases; Retinitis Pigmentosa; Visual Acuity
PubMed: 30200907
DOI: 10.1186/s12886-018-0814-2 -
BMJ Case Reports Sep 2018
Topics: Child; Coloboma; Humans; Iris; Male; Pars Planitis; Retinal Detachment; Retinal Perforations; Tomography, Optical Coherence; Treatment Outcome; Vision Disorders; Visual Acuity; Vitrectomy
PubMed: 30173139
DOI: 10.1136/bcr-2018-226919 -
American Journal of Ophthalmology Case... Sep 2018To describe the presentation, clinical course and management of a patient with bilateral maculopathy associated with sertraline.
PURPOSE
To describe the presentation, clinical course and management of a patient with bilateral maculopathy associated with sertraline.
OBSERVATIONS
We report a rare case of bilateral cystoid macular edema and subretinal fluid in a 78-year-old Asian Indian female who was on chronic sertraline therapy. The patient was initially misdiagnosed as intermediate uveitis and started on oral corticosteroids. However, multimodal imaging with fluorescein angiography and optical coherence tomography ruled out ocular inflammation. There was symmetrical bilateral macular involvement and changes on macular electroretinography, which provided clues to the diagnosis of toxic maculopathy. After cessation of sertraline therapy, the retinal pathology reversed with improvement in visual acuity.
CONCLUSIONS AND IMPORTANCE
Development of cystoid macular edema due to sertraline is a very rare adverse event and must be considered by psychiatrists and ophthalmologists. Our case demonstrates this rare toxicity along with its imaging features, and reversal on cessation of sertraline therapy.
PubMed: 29984334
DOI: 10.1016/j.ajoc.2018.06.021 -
Ocular Immunology and Inflammation 2019: To study the prevalence and time of onset of ocular complications in intermediate uveitis (IU) and to assess their effects on visual outcome in short-term and...
: To study the prevalence and time of onset of ocular complications in intermediate uveitis (IU) and to assess their effects on visual outcome in short-term and long-term follow-up. : A retrospective cohort study of patients with IU who had a minimal follow-up of one year. : 96 patients (174 eyes, 70% females) were included with a mean age at presentation of 30 years. Children constituted 38% of all patients. Mean follow- up was 64.9 months. Pars planitis was the most common form followed by sarcoidosis and multiple sclerosis. Cystoid macular edema (CME), cataract, epiretinal membrane and posterior synechiae were the most prevalent complications. Posterior synechiae, band keratopathy, cataract and papillitis at presentation were associated with worse presenting visual acuity (VA). Of the late-onset complications, glaucoma/ocular hypertension (OHT) was the most significantly associated with worse long-term VA. Most sight-threatening complications (namely CME and glaucoma) were diagnosed at presentation while late complications predominantly affected the posterior segment and included among others peripheral retinal elevations, vasoproliferative tumors, and vitreous hemorrhage. Median LogMAR VA improved at short-term and long-term follow-up, from 0.2 to 0.1 (p<0.001). Subgroup analysis revealed significant VA improvement for eyes with all the different complications except for eyes with glaucoma/OHT. : IU is a chronic low-grade uveitis that may be associated with protean early and late complications of the anterior or posterior segments or both. Optimal treatment regimens are imperative for the strict control of inflammation and proper management of complications thus allowing a favorable long-term prognosis.
Topics: Adolescent; Adult; Age Distribution; Aged; Child; Child, Preschool; Female; Follow-Up Studies; Glaucoma; Humans; Israel; Macular Edema; Male; Middle Aged; Ophthalmoscopy; Pars Planitis; Prevalence; Prognosis; Retrospective Studies; Sex Distribution; Slit Lamp Microscopy; Time Factors; Uveitis, Intermediate; Visual Acuity; Young Adult
PubMed: 29370567
DOI: 10.1080/09273948.2017.1420203 -
Archivos de La Sociedad Espanola de... Jun 2018
Topics: Adult; Erythema; Humans; Male; Pars Planitis; Tattooing; Tuberculin; Tuberculin Test; Tuberculosis, Ocular
PubMed: 29137823
DOI: 10.1016/j.oftal.2017.09.004 -
Pediatric Emergency Care Oct 2017Point-of-care ocular ultrasound can provide the clinician with more information about potential intraorbital and extraocular pathology, especially in cases when direct... (Review)
Review
Point-of-care ocular ultrasound can provide the clinician with more information about potential intraorbital and extraocular pathology, especially in cases when direct visualization of the eye is limited. This case report describes the findings in a pediatric patient who presented with a 1-month history of eye injection and worsening blurry vision. After point-of-care ultrasound demonstrated abnormal debris in the posterior vitreous cavity, subsequent evaluation revealed a diagnosis of pars planitis.
Topics: Child; Glucocorticoids; Humans; Male; Pars Planitis; Point-of-Care Systems; Ultrasonography; Vision Disorders
PubMed: 28968308
DOI: 10.1097/PEC.0000000000001272 -
Middle East African Journal of... 2017To study the patterns of intermediate uveitis in the pediatric age group in a referral eye care center in South India.
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.
Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Incidence; India; Male; Prognosis; Referral and Consultation; Retrospective Studies; Tertiary Care Centers; Time Factors; Uveitis, Intermediate; Visual Acuity
PubMed: 28936054
DOI: 10.4103/meajo.MEAJO_264_15 -
Graefe's Archive For Clinical and... Aug 2017
Topics: Adolescent; Cataract; Cataract Extraction; Child; Child, Preschool; Humans; Lens Implantation, Intraocular; Pars Planitis
PubMed: 28593425
DOI: 10.1007/s00417-017-3698-6