儿童葡萄膜炎临床分析

目的 分析儿童葡萄膜炎的临床特点、治疗效果、视力预后以及相关的全身疾病.方法 采用回顾性病例分析方法,收集近4年间在天津市眼科医院诊治的16周岁及以下的儿童葡萄膜炎患者106例(165只眼),通过详细询问病史、眼部或全身检查,确定葡萄膜炎类型;分析其治疗效果、并发症发生情况和视力预后.结果 在106例患者中,男45例,女61例(1:1.4);平均发病年龄为(10.9±3.3)岁.急性发病18例(17.0%),慢性发病37例(34.9%),反复发作者51例(48.1%).单眼发病47例,双眼发病59例.其中前葡萄膜炎52例(49.1%),中间葡萄膜炎31例(29.2%)、全葡萄膜炎15例(14.2%)和后匍萄膜炎8例(7.5%).感染性葡萄膜炎15例(14.2%),特发性或免疫相关性炎症91例(85.8%).根据病因分类,特发性前葡萄膜炎36例(34.0%),特发性中间葡萄膜炎31例(29.2%),特发性全葡萄膜炎13例(12.3%),合并幼年型关节炎10例(9.4%)和病毒性前葡萄膜炎5例(4.7%).42例患儿58只跟(35.2%)出现眼部并发症,主要有虹膜后粘连(21.8%)、并发白内障(17.0%)、继发青光眼(9.7%)、角膜带状变性(9.7%)和黄斑囊样水肿(8.5%).末次随访矫正视力低于0.5者45只眼(27.3%),低于0.1者16只眼(9.7%).结论 前葡萄膜炎是儿童时期常见的葡萄膜炎类型,其次为中间葡萄膜炎和全葡萄膜炎,后部葡萄膜炎较少见.多数患者表现为慢性特发性炎症,感染性葡萄膜炎较少见.儿童葡萄膜炎引发的各类并发症是致盲的主要原因.     

非感染性葡萄膜炎343例患者的分型、临床表现及并发症

目的　探讨非感染性葡萄膜炎患者的分型、临床表现及并发症。方法　选取2016年5月至2018年2月就诊于中山大学中山眼科中心葡萄膜炎专科并确诊为非感染性葡萄膜炎的患者343例（630眼）病历资料。记录入组患者一般资料,对患者进行详细的眼部检查。非感染性葡萄膜炎的诊断及分型参照2005年葡萄膜炎命名标准化工作组提出的相关标准。总结343例非感染性葡萄膜炎患者的分型、临床表现及并发症。结果　343例（630眼）非感染性葡萄膜炎患者中,56例单眼受累,287例双眼受累;男女比例为1.4∶1.0;发病年龄为21～50（36.3±12.4）岁。无明确病因的特发性患者122例,已明确病因患者221例,以Behcet病（30.3%）和VKH综合征（20.7%）最常见。343例非感染性葡萄膜炎患者按照炎症发生或累及的解剖部位分类,全葡萄膜炎（177/343,51.6%）占比最多,其他依次为中间葡萄膜炎（72/343,21.0%）、后葡萄膜炎（53/343,15.4%）、前葡萄膜炎（41/343,12.0%）。104例Behcet病性葡萄膜炎患者中出现复发性口腔溃疡91例、结节性红斑37例。71例VKH综合征性葡萄膜炎患者出现耳鸣39例、皮肤及毛发异常11例、头皮痛或感觉异常9例。343例非感染性葡萄膜炎患者眼部并发症以白内障（228例）最为常见,其次分别是视神经萎缩（39例）、黄斑萎缩（38例）和继发性青光眼（36例）。结论　非感染性葡萄膜炎患者中,全葡萄膜炎的发生率高于前葡萄膜炎;Behcet病性葡萄膜炎和VKH综合征性葡萄膜炎仍是我国最常见的全葡萄膜炎类型。     

24例少年儿童葡萄膜炎的临床观察

报道24例32眼少年儿童葡萄膜炎，占同期住院 病人的3.5‰，占住院葡萄膜炎患者的4.96%.其临床特点为：⑴发病隐袭，多表现为慢性隐匿性葡萄膜炎；⑵临床就诊晚，易误诊与漏诊；⑶治疗效果差，易出现并发症。提出早期诊断，探讨治疗方法有重要意义。 （中华眼底病杂志，1994，10：28-29）     

儿童非感染性葡萄膜炎的药物治疗

儿童葡萄膜炎占所有葡萄膜炎的5％～10％,多数起病隐匿、病程迁延,常合并多种眼部并发症.儿童葡萄膜炎多为非感染性,其中绝大多数为特发性,最常见的全身病因为幼年特发性关节炎.儿童葡萄膜炎治疗棘手,常用药物为糖皮质激素、抗代谢药、T细胞抑制剂.近年来生物制剂的使用为儿童非感染性葡萄膜炎的治疗提供了新方法.玻璃体腔植入糖皮质激素缓释装置可长时间控制眼内炎症,但在儿童中使用的安全性及有效性仍待进一步研究.     

幼年特发性关节炎伴发葡萄膜炎

幼年特发性关节炎（JIA）是指发生在16岁以下儿童以慢性关节炎为主要临床表现的全身多系统自身免疫性疾病,临床表现为不明原因的持续6周以上的关节肿胀或炎症。大约有10%的患者伴有葡萄膜炎症,具有发病隐匿、炎症反应轻、并发症多和视力损害重等特点。好发人群为关节炎发病年龄小、抗核抗体阳性的女性少关节型关节炎患者。典型临床表现为双眼不对称的慢性轻度前葡萄膜炎,常见致盲性并发症有角膜带状变性、虹膜后粘连、并发性白内障和继发性青光眼等。局部应用糖皮质激素、非甾体抗炎剂和散瞳剂是主要治疗措施,顽固性患者需全身加用糖皮质激素、免疫抑制剂或生物制剂治疗,并发性白内障患者在围手术期需加强抗炎治疗。对幼年关节炎患儿进行密切眼部随访和及早诊治,可减轻葡萄膜炎病情和降低致盲性并发症的损害。     

青少年型关节炎与葡萄膜炎

本文论述了青少年型关节炎与葡萄膜炎的关系。HLA-B27相关的脊椎关节炎儿童可伴发前葡萄膜炎。IgM类风湿因子阴性的青少年类风湿性关节炎(JRA)患者有20%并发双眼慢性非肉芽肿性前葡萄膜炎。JRA患者发生葡萄膜炎的危险因素有:女性、少数关节发病的关节炎、循环抗核抗体阳性和HLA-DW5及HLA-DPw2抗原阳性。关节炎患儿发病7年后很少再并发葡萄膜炎。葡萄膜炎的视力预后良好者占25%,一般者占50%,其余25%因并发性白内障或继发青光眼而较差。细胞毒素类药物的副作用较大,不宜用于治疗顽固性葡萄膜炎。继发性炎性青光眼的疗效不能令人满意,但晶体囊膜切开摘出术联合玻璃体切割术对并发性白内障的疗效较好。     

葡萄膜炎致盲目特点及原因探讨

目的 探讨我国常见类型葡萄膜炎的致盲特点与主要致盲原因。 方法 回顾分析1 214例各种类型葡萄膜炎患者的临床资料，着重分析各种葡萄膜炎中常见的致盲类型及致盲原因。 结果 1214例患者1892只患眼中，355只患眼致盲，占18.76%。致盲时平均年龄34.38岁，男女比例为1.52∶1。全葡萄膜炎致盲248只眼，占此类患眼的26.27%，其中，Behcet病和Vogt-小柳原田(VKH)综合征致盲者分别占51.61%和29.44%。全葡萄膜炎致盲者中，主要原因为并发性白内障，共89只眼，占35.89%；玻璃体混浊53只眼，占21.37%；继发性青光眼30只眼，占12.10%。前葡萄膜炎致盲79只眼，占此类患眼的10.73%，主要致盲原因为并发性白内障，共56只眼，占70.89%；继发性青光眼16只眼，占20.25%。后葡萄膜炎致盲15只眼，占此类患眼的15.63%，主要致盲原因为玻璃体混浊，共9只眼，占此类患眼的60.00%；黄斑病变3只眼，占此类患眼的20.00%。中间葡萄膜炎致盲13只眼，占此类患眼的11.21%，主要致盲原因为玻璃体混浊，共8只眼，占61.54%；并发性白内障5只眼，占38.46%。 结论 葡萄膜炎具有致盲率高及盲目主要发生于青壮年等特点；全葡萄膜炎，特别是Behcet病和VKH综合征是我国葡萄膜炎中最重要的致盲类型；并发性白内障、继发性青光眼等并发症是葡萄膜炎致盲的主要原因。 (中华眼底病杂志, 2005, 21: 350-352)     

葡萄膜炎的临床类型及病因探讨

目的 探讨葡萄膜炎的临床类型、病因及其发病年龄和性别构成。 方法 对1996年1月至2001年12月，于中山眼科中心葡萄膜炎专科就诊的葡萄膜炎患者的资料进行回顾性分析，特别是按照解剖位置分类并结合病因分类方法，对葡萄膜炎的病因、类型进行探讨，并就发病的年龄和性别等因素进行分析讨论。 结果 各种类型葡萄膜炎患者共计1 214例，男698人，女516人，平均发病年龄34-43岁。其中前葡萄膜炎546例，占所有患者的44.98%；全葡萄膜炎530例，占43.66%；中间葡萄膜炎78例，占6.43%；后葡萄膜炎60例，占4.94%。能够确定病因或归于特定类型的患者共703例，占57.91%，其余为特发性患者511例。前葡萄膜炎中特发性患者最多，共316例占57.88%，其次为Fuchs综合征85例和关节强直性脊椎炎45例；全葡萄膜炎中最常见的类型为BehÇet病218例(41.13%)和Vogt-小柳原田综合征196例(36.98%)；中间和后葡萄膜炎均为特发性。 结论 葡萄膜炎多发于青壮年；男性患者整体上稍多于女性；常见类型为特发性前葡萄膜炎、BehÇet小柳原田综合征等；解剖位置结合病因进行分类是较为合理的葡萄膜炎分类方法。 (中华眼底病杂志, 2002, 18: 253-255)     

650例前葡萄膜炎临床分析

目的探讨前葡萄膜炎的病因、类型、临床特点及预后。方法回顾性病例研究。分析2006年12月至2012年7月就诊于我院葡萄膜炎专科的650例前葡萄膜炎患者（856眼）的临床资料,根据病史、临床表现、合并全身性疾病、辅助检查及实验室检查等,对前葡萄膜炎的病因、临床特点、治疗效果及预后进行探讨。结果650例前葡萄膜炎患者（856眼）中单眼发病444例,双眼发病206例,男394例,女256例,男女比例为1．5：1;平均发病年龄（39．0±15．0）岁,20～50岁之间的青壮年患者占总病例的71．4％。急性期689眼,慢性期167眼。按病因主要分为特发性前葡萄膜炎（243例,37．4％）,不伴发全身关节病变的HLA—B27相关性前葡萄膜炎（123例,18．9％）,强直性脊柱炎（105例,16．2％）,Fuchs综合征（74例,11.4％）和病毒感染（44例,6．8％）。各种并发症发生率为39．5％,主要为并发性白内障（41．1％）和继发性青光眼（35．1％）。治疗后视力≥0．5者占75．4％,0．05～者占20．3％,〈0．05者占4-3％。结论前葡萄膜炎发病率高．病因复杂多样。易复发,如治疗不当将产生严重并发症。因此应对前葡萄膜炎患者进行详细、系统的检查,积极查因,从而指导临床治疗及预后。     

前葡萄膜炎的临床诊治分析

目的 探讨前葡萄膜炎的临床特点、治疗效果、视力预后及诊治中存在的问题.方法 回顾性系列病例研究.收集2001年1月至2007年6月期间在天津市眼科医院诊治的各类前葡萄膜炎患者478例,男性281例,女性197例;平均发病年龄(36±15)岁.通过详细临床检查、实验室检查和治疗观察,对其临床类型、疗效、并发症及视力预后进行分析.结果 急性前葡萄膜炎242例(50.6%),复发性前葡萄膜炎197例(41.2%),慢性前葡萄膜炎39例(8.2%).依据病因分为特发性前葡萄膜炎231例(48.3%),不伴有全身疾病的人类白细胞抗原-B27阳性葡萄膜炎76例(15.9%),病毒性葡萄膜炎52例(10.9%),合并强直性脊柱炎34例(7.1%),Fuchs综合征29例(6.1%),青光眼睫状体炎综合征24例(5.0%)及幼年性关节炎合并葡萄膜炎17例(3.6%).各种并发症发生率为31.6%(151例),轻度视力损害(低于0.5)发生率为11.1%(53例),中度和重度视力损害(低于0.3)为7.5%(36例),致肓率(低于0.05)为2.5%(12例).结论 前葡萄膜炎临床类型多样,特发性前葡萄膜炎、人类白细胞抗原-B27相关性前葡萄膜炎及病毒性前葡萄膜炎是常见类型,完善特异性实验室检查项目有助于病因诊断和给予适当治疗.     

Demographic and Clinical Features of Pediatric Uveitis in Israel

ABSTRACT

Purpose: To report the epidemiology, etiology, ocular characteristics, treatment and visual outcome of pediatric uveitis in Israel.

Methods: Retrospective study from two tertiary uveitis centers.

Results: Included were 107 patients (182 eyes), 55% females. Mean age at diagnosis 8.8 years. Uveitis was predominantly anterior, idiopathic, bilateral, and chronic. Systemic associations were seen in 36% of patients of which the most common disease was juvenile idiopathic arthritis. Infectious uveitis accounted for 37% of posterior uveitis cases of which toxoplasmosis was the most common cause. Anterior segment complications were commonly observed at presentation (41%); the most predominant were posterior synechiae, cataract, and band keratopathy. The most common posterior segment complications were papillitis, epiretinal membrane, and macular atrophy/scar. Ninety-three percent of eyes had visual acuity >20/40 at last follow-up.

Conclusion: The pattern of pediatric uveitis in Israel is similar to that in the western world. Visual outcome was good in most eyes.     

Recent advances in uveitis of juvenile idiopathic arthritis

Chronic scarring-type uveitis is a frequent extra-articular manifestation of juvenile idiopathic arthritis. It occurs in about 20% of children with this disease, commencing typically within a few years from its onset. The risk of uveitis is greatest in antinuclear antibody-positive girls with early onset oligoarthritis. The classic clinical picture is chronic bilateral anterior uveitis, usually asymptomatic until substantial damage to intraocular structures occurs. In view of the asymptomatic nature of the condition, routine screening of juvenile idiopathic arthritis patients 2-4 times a year is crucial to prevent complications. The treatment consists of topical corticosteroids and mydriatics, in severe cases with immunosuppressive agents, and surgical management of complications. Although the prognosis of uveitis is improving, there are cases refractory to standard regimens. Patients in whom uveitis commences prior to the onset of arthritis present a special problem.     

Epidemiology of uveitis in juvenile idiopathic arthritis from a national paediatric rheumatologic and ophthalmologic database

BACKGROUND: Uveitis is a frequent and potentially vision-threatening manifestation of juvenile idiopathic arthritis (JIA). There are only a few population-based studies providing data on the frequency and severity of uveitis. METHODS: Documentation of patients with JIA was collected in a national database. An analysis of the paediatric rheumatologic and ophthalmologic data collected from all patients that were included in 2002 was performed. RESULTS: Uveitis was documented in 12 % of a total of 3271 JIA patients: extended oligoarthritis (25 %), persistent oligoarthritis (16 %), seronegative polyarthritis (4 %), seropositive polyarthritis (2 %), psoriatic arthritis (10 %), enthesitis-related arthritis (ERA) (7 %), systemic arthritis (1 %), other arthritis forms (11 %). Ophthalmologic data were available from 115 uveitis patients (28 %). Mean age at onset of uveitis was 5.2 (SD 3.2) years. JIA patients with uveitis were significantly younger at onset of arthritis (3.8 vs. 7.0 years), and were more often girls (74 vs. 63 %) or ANA-positive (86 vs. 42 %) than the patients without uveitis. Uveitis complications were present in 45 % at initial presentation of uveitis. After a mean duration of 5.6 years, complications were noted in 56 %, and included band keratopathy (29 %), posterior synechiae (27 %), cataract (26 %), glaucoma (8 %), and macula oedema (6 %). Final visual acuity was less than 20/50 in 31 % and less than 20/200 in 12 % of eyes. In patients with uveitis, immunosuppressive or immunomodulatory drugs were used significantly more often than in patients without uveitis (75 % vs. 43 %). CONCLUSIONS: The nationwide data documents the spectrum of uveitis in patients with JIA, the complications and the therapy for uveitis. The high rate of uveitis complications at the time of diagnosis points out the need for early ophthalmologic screening and therapy, and for a close collaboration between ophthalmologist and paediatric rheumatologist.     

Pattern of childhood-onset uveitis in a referral center in Tunisia, North Africa

PURPOSE: To analyze the pattern of childhood uveitis in a referral center in Tunisia, North Africa. METHODS:The study included 64 patients with uveitis examined at the Department of Ophthalmology of Monastir (Tunisia) from January 1994 to July 2005. All patients had a comprehensive ocular and systemic history, including an extensive review of medical systems. Complete ophthalmic examination was performed in all cases, including best-corrected Snellen visual acuity, slit-lamp examination, applanation tonometry, and dilated fundus examination with 3-mirror lens. Standard diagnostic criteria were employed for all syndromes or entities of uveitis. RESULTS: The mean age at onset of uveitis was 12.4 years. The male-to-female ratio was 0.68. The process was unilateral in 51.6% of patients. Mean follow-up was 43.2 months. Anterior and intermediate uveitis each represented 31.25% of cases, posterior uveitis 20.3%, and panuveitis 17.2%. Noninfectious uveitis (75%) was the most frequent type of inflammation. Idiopathic uveitis was found in 50% of patients. Infectious uveitis was responsible for 25% of the cases, with toxoplasmosis (14.1%) being the most frequent cause. Twenty percent of the patients had systemic associations; juvenile idiopathic arthritis was found in 6.25%. Ocular complications occurred in 74.7% of affected eyes, of which the most common were posterior synechiae (28.4%), cataract (17.9%), cystoid macular edema (19%), and optic disc edema (32.6%). Fifty-seven affected eyes (60%) had a final visual acuity more than 20/40 and nine (9.5%) had a final visual acuity less than 20/200. CONCLUSIONS: In a hospital population in Tunisia, a specific cause of uveitis in children was found in half the patients. Idiopathic intermediate uveitis was the leading cause of uveitis in our study, followed by idiopathic anterior uveitis and toxoplasmosis. Uveitis associated with juvenile idiopathic arthritis was rare. Visual prognosis appeared to be good.     

Assessment of the ocular changes in children with juvenile idiopathic arthritis

PURPOSE: To analyse the frequency of uveitis and other ocular changes in children with juvenile idiopathic arthritis. MATERIAL AND METHODS: We carried out ophthalmologic examination in children and adolescents with juvenile idiopathic arthritis, in age between 3 and 20 years. During the examination we evaluated vision acuity, refraction, anterior and posterior part of the eye and intraocular pressure. RESULTS: A total of 48 (68%) girls and 22 (32%) boys participated in our study, whose mean age was 13.2 years (SD = 3.8). The most frequent onset of juvenile idiopathic arthritis was oligoarticular form of the disease (62%). Only in 42% of the studied group there were no significant abnormalities of the ocular system. Anterior uveitis was diagnosed in 5 patients (7%) including 4 (5.7%) girls and 1 (1.4%) boy. Complications appeared in 2 children in the form of cataract and band keratopathy which both resulted in considerable impairment of visual acuity. Mean duration of juvenile idiopathic arthritis before the onset of uveitis was 5.2 years. There were other ocular changes in the studied group, among which the most common were: conjunctivitis--24%, abnormalities of the retina--11%, glaucoma--4% and other changes. CONCLUSIONS: In majority of the children with juvenile chronic arthritis different abnormalities of the eyes were diagnosed. All the patients with juvenile idiopathic arthritis should be under close surveillance of the ophthalmologist, irrespective of the disease duration.     

Dengue Fever

PURPOSE: To summarize the prevalence and patterns of uveitis in children. METHODS: Pertinent articles were reviewed. RESULTS: Children constitute 5-10% of the patients with uveitis seen at tertiary referral centers, and girls appear to develop uveitis slightly more frequently than boys. Among all children with intraocular inflammation, anterior uveitis accounts for 30-40%, posterior uveitis accounts for 40-50%, intermediate uveitis accounts for 10-20%, and diffuse uveitis accounts for 5-10%. The most common cause of anterior uveitis is juvenile idiopathic arthritis (JIA), whereas the most frequent type of posterior uveitis is toxoplasmic retinochoroiditis. Most cases of intermediate and diffuse uveitis are bilateral, chronic, and idiopathic. The most common causes of vision loss in children with uveitis are cataract, band keratopathy, glaucoma, and cystoid macular edema. Up to one-third of the children with uveitis are left with severely impaired vision as a result of these complications. CONCLUSIONS: Uveitis is an important cause of ocular morbidity in children. Prompt diagnosis and treatment is essential to minimize the risk of long-term vision loss.     

Clinical course and outcome of uveitis in children.

PURPOSE: We sought to evaluate the clinical course, complications, and visual outcome of pediatric uveitis. METHODS: Our sample included 38 consecutive children with uveitis treated between 1986 and 2002: 15 with idiopathic uveitis, 10 with Behcet disease, 9 with juvenile rheumatoid arthritis, 4 with other diagnoses. The last group was excluded from the analysis because of its small size. Appropriate ophthalmologic and laboratory examinations were obtained. Treatment consisted of topical, periocular, or systemic steroids with or without immunosuppression. RESULTS: Complications occurred in all 3 groups, although they tended to be more severe in the patients with juvenile rheumatoid arthritis. Visual acuity improved from presentation to final examination; the difference was statistically significant for the patients with idiopathic uveitis (P < 0.0005) and Behcet disease (P = 0.004). CONCLUSIONS: These findings support an intensive treatment approach to childhood uveitis. The visual prognosis is good even in patients with a severe clinical course.     

Prognostic factors in the uveitis of juvenile rheumatoid arthritis

Risk factors for significant visual loss were investigated in 51 patients with iridocyclitis associated with juvenile rheumatoid arthritis (JRA). Average follow-up was 12.7 years. Of 89 eyes with uveitis, 22% had visual loss to 20/200 or worse, 46% had cataracts, 30% had band keratopathy, and 27% had glaucoma. Severity of visual loss and complications correlated with the degree of inflammation found on initial ocular examination. Of 58 eyes that were initially normal or had signs of mild inflammation (cells, flare, keratitic precipitates), 3% had final vision of 20/200 or worse, 28% had cataracts, 5% had band keratopathy, and 17% had glaucoma. Of 31 eyes with posterior synechiae on initial examination, 58% had final vision of 20/200 or worse, 81% had cataracts, 77% had band keratopathy, and 45% had glaucoma. When arthritis clearly preceded uveitis, 6% of patients had a poor visual outcome compared to 67% of patients whose initial manifestation of JRA was uveitis. Systemic corticosteroid administration used primarily for arthritis correlated with cataract formation.     

Surgery for hypotony in patients with juvenile idiopathic arthritis-associated uveitis

PURPOSE: To describe the clinical response to cyclitic membrane excision of eyes with juvenile idiopathic arthritis (JIA)-associated uveitis and hypotony. METHODS: The clinical records of patients with JIA-associated uveitis in a tertiary referral center were reviewed. Those patients with JIA-associated uveitis and hypotony who underwent cyclitic membrane excision were included in the study. Patients with hypotony secondary to active inflammation, retinal detachment, and surgical intervention (filtering, cyclo-destructive procedures, and glaucoma valve implantation) were excluded. RESULTS: Two pediatric and two adult patients (4 eyes) were identified. The range of pre-operative intraocular pressure (IOP) was 0-5 mmHg. The two adult patients were noted to have atrophic ciliary processes intra-operatively, while the two pediatric patients had normal ciliary processes. At six months follow-up, the adult patients had IOPs of 5 mmHg, while the two pediatric patients had IOPs of 16 mmHg. At last consultation (mean duration of follow-up: 3.6 years), IOP was normal in all eyes. None of the eyes had a decrease in vision. CONCLUSIONS: Release of traction on the ciliary body by inflammatory membranes may play a role in the management of hypotony in patients with JIA-associated uveitis. However, even though the IOP was successfully elevated, preventing phthisis, vision remained poor due to the long-standing complications secondary to chronic uveitis. This emphasizes the critical importance of early diagnosis and appropriate treatment of the inflammation before vision-robbing complications occur.