Intermediate uveitis in childhood preceding the diagnosis of multiple sclerosis: a 13-year follow-up

Intermediate uveitis in a pediatric Italian population

PURPOSE

To investigate clinical data, outcome, and treatment of intermediate uveitis in children.

METHODS

Retrospective cohort study, including 116 children affected by intermediate uveitis.

RESULTS

Sixty-two percent of patients were males. Ocular involvement was bilateral in 84%. Mean age at uveitis onset was 10.3 ± 3.6 years and 12.2 ± 7 years at first visit. Ninety-seven percent were classified as having idiopathic uveitis. The incidence of ocular complications during follow-up was 0.131/eye-year. Macular edema or a marked vitreous haze at presentation may be risks factors for incident visual loss. The most frequent causes of visual loss were macular edema (64%) and cataract (21%).

CONCLUSIONS

Most cases are idiopathic (pars planitis); only few children presented associated systemic disease. Macular edema and severe vitritis at presentation are associated with increased risk of visual impairment. Cystoid macular edema is the main cause of visual impairment.

Mucoviscidose, uvéite infantile et sclérose en plaques à l’âge adulte

We report the case of a patient with cystic fibrosis who suffered severe bilateral uveitis, with hypopyon, retinal vasculitis, and polyarthritis when he was 6 years old. No etiology could be found. Multiple sclerosis began when he was 22 years old. This panuveitis was clinically very different from the uveitis usually associated with multiple sclerosis. Polyarthritis and skin vasculitis have been reported in the course of cystic fibrosis, but no uveitis nor retinal vasculitis have been described. This raises the question of the role of multiple sclerosis and cystic fibrosis in the pathogenesis of this case of uveitis.

Special considerations in the evaluation and management of uveitis in children

PURPOSE

To review issues related to the diagnosis, examination, and treatment of children with uveitis that are important for ophthalmologists.

DESIGN

Literature review.

METHOD

A review was made of pertinent reports from the medical literature, with commentary based on the authors' experiences and on discussions at an international workshop.

RESULTS

There are differences between children and adults in the differential diagnosis and manifestations of uveitis that should be considered during evaluation. There may be a higher risk of some ocular complications such as uveitic glaucoma, and the presence of other unique complications, such as amblyopia, in young patients during follow-up. With regard to treatment, children with uveitis may have unique dosing requirements and drug-associated risks such as growth retardation with systemic corticosteroids that must be considered. Examination and treatment may also be more difficult with children because of problems with patient cooperation.

CONCLUSIONS

There are unique patient care issues associated with uveitis in children that must be considered by care providers. Attention to these issues will improve the well-being of this patient population.