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Nguyen AT, Rousseau A, Bodaghi B, Rossi-Semerano L, Galeotti C, Da Cunha E, Eid L, Labetoulle M, Barreau E, Titah C, Toutée A, Koné-Paut I, Dusser P, Borocco C. Paediatric non-infectious granulomatous uveitis: a retrospective cohort study. Rheumatology (Oxford) 2024:keae253. [PMID: 38710493 DOI: 10.1093/rheumatology/keae253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/10/2024] [Accepted: 04/21/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Paediatric granulomatous uveitis (PGU) is rare. In addition, lack of awareness often leads to delayed diagnosis and poor visual outcome. Identifying the underlying cause and deciding how best to treat each patient is challenging. OBJECTIVES To evaluate the demographics, aetiologies, complications, treatments, and visual prognosis of paediatric non-infectious granulomatous uveitis. METHODS Retrospective chart review of non-infectious PGU occurring in children before the age of 16 years recruited from the Paediatric Rheumatology Unit, Bicêtre Hospital, France, from 2001 to 2023. RESULTS We included 50 patients with 90 affected eyes: 29 with idiopathic uveitis, 15 with sarcoidosis, 5 with juvenile idiopathic arthritis, and one with Vogt-Koyanagi-Harada disease. Median age at diagnosis was 9.8 years (range 7.2-12.5). The sex-ratio M/F was 0.52. The most common features of PGU were: panuveitis (56%), bilateral (84%), and chronic (84%). Sarcoidosis was the most frequent diagnosis after idiopathic disease, particularly in the presence of lymphopenia and hypergammaglobulinemia. Uveomeningitis was present in 12% of cases. Upon diagnosis, ocular complications were present in 68 of 90 eyes (76%) particularly in cases of panuveitis. The most commonly used treatments were systemic corticosteroids (72%) and methotrexate (80%). Twenty-three percent of eyes were in remission at last follow-up, 68% were inactive and 4% remained active. The median duration of follow-up was 5.8 years. CONCLUSION We report the largest cohort of PGU. PGU were mostly idiopathic and had a high rate of complications. Sarcoid and idiopathic panuveitis are serious illnesses in which disease-modifying therapy should be initiated at diagnosis to improve management.
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Affiliation(s)
- Ai Tien Nguyen
- Department of Paediatric Rheumatology, CeReMAIA, ERN RITA member, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Antoine Rousseau
- Department of Ophthalmology, OPHTARA, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
- IDMIT Infrastructure, CEA, Paris-Saclay University, Inserm U1184, Fontenay-aux-Roses, France
| | - Bahram Bodaghi
- Department of Ophthalmology, la Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Linda Rossi-Semerano
- Department of Paediatric Rheumatology, CeReMAIA, ERN RITA member, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Caroline Galeotti
- Department of Paediatric Rheumatology, CeReMAIA, ERN RITA member, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Elodie Da Cunha
- Department of Ophthalmology, OPHTARA, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Laura Eid
- Department of Ophthalmology, OPHTARA, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Marc Labetoulle
- Department of Ophthalmology, OPHTARA, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
- IDMIT Infrastructure, CEA, Paris-Saclay University, Inserm U1184, Fontenay-aux-Roses, France
| | - Emmanuel Barreau
- Department of Ophthalmology, OPHTARA, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Cherif Titah
- Department of Ophthalmology, Adolphe de Rothschild Hospital, Paris, France
| | - Adélaïde Toutée
- Department of Ophthalmology, la Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Koné-Paut
- Department of Paediatric Rheumatology, CeReMAIA, ERN RITA member, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Perrine Dusser
- Department of Paediatric Rheumatology, CeReMAIA, ERN RITA member, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Charlotte Borocco
- Department of Paediatric Rheumatology, CeReMAIA, ERN RITA member, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
- Department of General Paediatrics, Aix-Pertuis Hospital, Aix-en-Provence, France
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Cunha ED, Mariette X, Desmoulins F, Bergé E, Nocturne G, Benmalek A, Haigh O, Seror R, Labetoulle M, Rousseau A. Associations between ocular and extra-ocular assessment in primary Sjögren's syndrome. Joint Bone Spine 2022; 89:105426. [PMID: 35716880 DOI: 10.1016/j.jbspin.2022.105426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 04/25/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess associations between ophthalmological features and the main systemic biomarkers of primary Sjögren's Syndrome (pSS), and to identify systemic biomarkers associated with severe keratoconjunctivitis sicca (KCS) in pSS patients. METHODS In this cross-sectional study, data was retrospectively extracted from the monocentric cohort of the French reference centre for pSS. We analysed data from the initial visit of patients admitted for suspicion of pSS and included patients validating pSS ACR/EULAR classification criteria. Ophthalmological assessment included Schirmer's test, tear break-up time, ocular staining score (OSS), and visual analogue scale (DED-VAS) for dry eye disease (DED) symptoms. Results of minor salivary gland biopsy, unstimulated whole salivary flow rate, anti-SSA/Ro antibodies, anti-SSB/La antibodies, and rheumatoid factor (RF) were collected. RESULTS A total of 253 patients (245 females) with confirmed pSS, aged 56.6 ± 13.0 years, were included, among which 37% had severe KCS. Multivariate analysis showed that the presence of anti-SSA/Ro antibodies, anti-SSB/La antibodies and RF were associated with conjunctival OSS (odds ratio -OR- = 1.25 per OSS unit increase; confidence interval -CI- 95% = 1.05 - 1.49; p = 0.01; OR = 1.31 per OSS unit increase; CI95% = 1.09 - 1.58, p = 0.002, and OR = 1.34 per OSS unit increase; CI95% = 1.12-1.59; p = 0.001, respectively). Both anti-SSB/La antibodies and DED-VAS ≥ 5 were significantly associated with severe KCS (OR = 2.03; CI95% = 1.03 - 4.00; p < 0.05 and OR = 2.52, CI95% = 1.31 - 4.90; p < 0.01, respectively). CONCLUSIONS Association between conjunctival OSS and systemic biomarkers of pSS indicate the crucial importance of conjunctival staining when pSS is suspected as a cause of DED. Conversely, patients with anti-SSB and DED-VAS ≥ 5 features should be prioritized for extensive evaluation by an ophthalmologist due to their association with severe KCS.
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Affiliation(s)
- Elodie Da Cunha
- Department of Ophthalmology, Assistance Publique Hôpitaux de Paris, Centre de Référence Maladies Rares en Ophtalmologie (OPHTARA), F-94275 Le Kremlin-Bicêtre, France
| | - Xavier Mariette
- Department of Rheumatology, Assistance Publique Hôpitaux de Paris, Hôpital Bicêtre, National Reference Center for Rare Systemic Autoimmune Diseases, Le Kremlin-Bicêtre, France; Université Paris-Saclay, INSERM, CEA, Center for Immunology of Viral, Auto-immune, Haematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Frédéric Desmoulins
- Department of Rheumatology, Assistance Publique Hôpitaux de Paris, Hôpital Bicêtre, National Reference Center for Rare Systemic Autoimmune Diseases, Le Kremlin-Bicêtre, France
| | - Elisabeth Bergé
- Department of Rheumatology, Assistance Publique Hôpitaux de Paris, Hôpital Bicêtre, National Reference Center for Rare Systemic Autoimmune Diseases, Le Kremlin-Bicêtre, France
| | - Gaetane Nocturne
- Department of Rheumatology, Assistance Publique Hôpitaux de Paris, Hôpital Bicêtre, National Reference Center for Rare Systemic Autoimmune Diseases, Le Kremlin-Bicêtre, France
| | - Anouar Benmalek
- Department of biomathematics, Faculty of Pharmacy, Paris-Sud University, Chatenay-Malabry, France
| | - Oscar Haigh
- Université Paris-Saclay, INSERM, CEA, Center for Immunology of Viral, Auto-immune, Haematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Raphaele Seror
- Department of Rheumatology, Assistance Publique Hôpitaux de Paris, Hôpital Bicêtre, National Reference Center for Rare Systemic Autoimmune Diseases, Le Kremlin-Bicêtre, France
| | - Marc Labetoulle
- Department of Ophthalmology, Assistance Publique Hôpitaux de Paris, Centre de Référence Maladies Rares en Ophtalmologie (OPHTARA), F-94275 Le Kremlin-Bicêtre, France; Université Paris-Saclay, INSERM, CEA, Center for Immunology of Viral, Auto-immune, Haematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Antoine Rousseau
- Department of Ophthalmology, Assistance Publique Hôpitaux de Paris, Centre de Référence Maladies Rares en Ophtalmologie (OPHTARA), F-94275 Le Kremlin-Bicêtre, France; Université Paris-Saclay, INSERM, CEA, Center for Immunology of Viral, Auto-immune, Haematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France.
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Da Cunha E, Georgeon C, Bouheraoua N, Putterman M, Brignole-Baudouin F, Borderie VM. Multimodal imaging of Hurler syndrome-related keratopathy treated with deep anterior lamellar keratoplasty. BMC Ophthalmol 2020; 20:433. [PMID: 33129306 PMCID: PMC7603712 DOI: 10.1186/s12886-020-01689-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Hurler syndrome-associated keratopathy is an exceedingly rare corneal disorder that requires corneal transplantation in advanced stages. Precise assessment of the corneal condition is necessary for deciding which type of keratoplasty (i.e., deep anterior lamellar or penetrating) should be proposed. We aimed to confront the results of multimodal imaging with those of histology in a case of Hurler syndrome-associated keratopathy. Case presentation A 16-year-old patient with Hurler’s syndrome treated with hematopoietic stem cell transplantation was referred for decreased vision related to advanced keratopathy. The patient was treated with deep anterior lamellar keratoplasty (DALK) in both eyes with uncomplicated outcome. Visual acuity improved from 0.1 (20/200) preoperatively to 0.32 (20/63) and 0.63 (20/32) after transplantation. The corneal endothelial cell density was 2400 cells/mm2 in both eyes 3 years after transplantation. In vivo confocal microscopy (IVCM) and spectral domain optical coherence tomography (SD-OCT) were performed preoperatively. The corneal buttons retrieved during keratoplasty were processed for histology. In SD-OCT scans, corneal opacities appeared as diffuse stromal hyperreflectivity associated with increased corneal thickness. IVCM showed diffuse cytoplasmic granular hyperreflectivity and rounded/ellipsoid aspects of keratocytes, presence of small intracellular vacuoles, and hyperreflective epithelial intercellular spaces. Bowman’s layer was thin and irregular. The corneal endothelium was poorly visualized but no endothelial damage was observed. Histology showed irregular orientation and organization of stromal lamellae, with the presence of macrophages whose cytoplasm appeared clear and granular. A perinuclear clear halo was visible within the epithelial basal cells. Bowman’s layer featured breaks and irregularities. Conclusions The observed corneal multimodal imaging features in mucopolysaccharidosis-related keratopathy were concordant with histology. Compared with standard histology, multimodal imaging allowed additional keratocyte features to be observed. It revealed both morphological and structural changes of all corneal layers but the endothelium. This information is essential for therapeutic management which should include DALK as the first-choice treatment in case of impaired visual acuity.
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Affiliation(s)
- Elodie Da Cunha
- GRC32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne université, Centre Hospitalier National d'Ophtalmologie des 15-20, 28 rue de Charenton, 75571 Cedex 12, Paris, France
| | - Cristina Georgeon
- GRC32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne université, Centre Hospitalier National d'Ophtalmologie des 15-20, 28 rue de Charenton, 75571 Cedex 12, Paris, France
| | - Nacim Bouheraoua
- GRC32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne université, Centre Hospitalier National d'Ophtalmologie des 15-20, 28 rue de Charenton, 75571 Cedex 12, Paris, France
| | - Marc Putterman
- Laboratoire (2), Centre Hospitalier National d'Ophtalmologie des 15-20, Paris, France
| | | | - Vincent M Borderie
- GRC32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne université, Centre Hospitalier National d'Ophtalmologie des 15-20, 28 rue de Charenton, 75571 Cedex 12, Paris, France.
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