Patterns of childhood-onset uveitis in a referral center in Turkey
Tóm tắt
This study aimed to investigate the frequency and characteristics of childhood-onset uveitis and evaluate the rate and specific causes of visual loss in this population. The data of 121 patients (179 eyes) with uveitis starting before ≤16 years and followed up for at least 6 months were retrospectively evaluated. Age at onset, sex, laterality, associated systemic disease, laboratory data, therapeutic strategies, surgeries, final visual acuity, and causes leading to visual acuity ≤20/200 were analyzed. Childhood-onset uveitis made up 9.6% of our uveitis patients. The mean age at onset was 11.7 years (1–16) and the mean follow-up period was 38.5 months (6–148). Forty-three patients (35.5%) were female and 78 were male (64.5%). The disease was bilateral in 58 (47.9%) and unilateral in 63 (52.1%) patients. Uveitis was mostly (59.5%) seen between 12 and 16 years of age. Pars planitis, observed in 29 (24%) patients, was the leading cause of childhood-onset uveitis. Uveitis was idiopathic in 20 (16.5%) of patients. The most frequently associated diseases were Behcet’s disease (BD) in 20 (16.5%), toxoplasmosis in 16 (13.2%), and juvenile idiopathic arthritis (JIA) in 8 (6.6%) patients. Anterior uveitis was observed in 38 (31.4%), intermediate uveitis in 31 (25.6%), posterior uveitis in 30 (24.8%), and panuveitis in 22 (18.2%) patients. The final visual acuity was ≤20/200 in 32/179 eyes (17.9%) of 27/121 patients (22.3%). The most often ocular complication leading to visual acuity ≤20/200 was optic atrophy and had been observed in 14 of 32 eyes (43.7%). Macular scar observed in five eyes (15.6%) was the second most often complication. Etiological distribution of 27 patients with visual acuity ≤20/200 was as follows: 12 had BD (44.4%), 5 had idiopathic uveitis (18.5%), 4 had pars planitis (14.8%), 3 had toxoplasmosis (11.1%), 2 had JIA (7.4%), and 1 had toxocara (3.7%). Although rare, childhood-onset uveitis has a blinding potential and causes visual loss in up to 22.3% of the patients. In endemic areas like Turkey, BD may be the most common uveitis-associated systemic disease and the leading cause of visual loss in childhood uveitis as adulthood.
Tài liệu tham khảo
Zierhut M, Michels H, Stübiger N, Besch D, Deuter C, Heiligenhaus A (2005) Uveitis in children. Int Ophthalmol Clin 45:135–156
Gilles CL (1989) Uveitis in childhood—part I. Anterior. Ann Ophthalmol 21:13–19
Tugal-Tutkun I, Havrlikova K, Power WJ, Foster CS (1996) Changing patterns in uveitis of childhood. Ophthalmology 103:375–383
Rosenberg KD, Geuer WJ, Davis JL (2004) Ocular complications of pediatric uveitis. Ophthalmology 111:2299–2306
Edelsten C, Reddy MA, Stanford MR, Graham EM (2003) Visual loss associated with pediatric uveitis in English primary and referral centers. Am J Ophthalmol 135:676–680
Jabs DA, Nussenblatt RB, Rosenbaum JT (2005) Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol 140:509–516
International Study Group for Behçet’s Disease (1990) Criteria for diagnosis of Behçet’s disease. Lancet 335:1078–1080
De Boer J, Wulffraat N, Rothova A (2003) Visual loss in uveitis of childhood. Br J Ophthalmol 87:879–884
Smith JA, Mackensen F, Sen N et al (2009) Epidemiology and course of disease in childhood uveitis. Ophthalmology 116:1544–1551
Perkins ES (1966) Pattern of uveitis in children. Br J Ophthalmol 50:169–185
Kimura SJ, Hogan MJ (1964) Uveitis in children: analysis of 274 cases. Trans Am Ophthalmol Soc 62:173–192
Kadayıfçılar S, Eldem B, Tumer B (2003) Uveitis in childhood. J Pediatr Ophthalmol Starbismus 40:335–340
Soylu M, Ozdemir G, Anli A (1997) Pediatric uveitis in southern Turkey. Ocul Immunol Inflamm 5:197–202
Hamade IH, Al Shamsi HN, Al Dhibi H, Chacra CB, Abu El-Asrar AM, Tabbara KF (2009) Uveitis survey in children. Br J Ophthalmol 93:569–572
Kanski JJ, Shun-Shin GA (1984) Systemic uveitis syndromes in childhood: an analysis of 340 cases. Ophthalmology 91:1247–1252
Paivonsalo-Hietanen T, Tuominen J, Saari KM (2000) Uveitis in children: population-based study in Finland. Acta Ophthalmol Scand 78:84–88
Pivetti-Pezzi P (1996) Uveitis in children. Eur J Ophthalmol 6:293–298
Foster CS (2003) Diagnosis and treatment of juvenile idiopathic arthritis-associated uveitis. Curr Opin Ophthalmol 14:395–398
Kump LI, Cervantes-Castañeda RA, Androudi SN, Foster CS (2005) Analysis of pediatric uveitis cases at a tertiary referral center. Ophthalmology 112:1287–1292
Espinosa G, Arostegui JI, Plaza S, Rius J, Cervera R, Yagüe J, Font J (2005) Behçet’s disease and hereditary periodic fever syndromes: casual association or causal relationship? Clin Exp Rheumatol 23(4 Suppl 38):S64–S66
Demirkaya E, Ozen S, Bilginer Y et al (2011) The distribution of juvenile idiopathic arthritis in the eastern Mediterranean: results from the registry of the Turkish Paediatric Rheumatology Association. Clin Exp Rheumatol 29:111–116
Cunnigham ET Jr (2000) Uveitis in children. Ocul Immunol Inflamm 8:251–261
Holland GN, Stiehm ER (2003) Special considerations in the evaluation and management of uveitis in children. Am J Ophthalmol 135:867–878
Tugal-Tutkun I, Urgancioglu M (2003) Childhood-onset uveitis in Behçet’s disease: a descriptive study of 36 cases. Am J Ophthalmol 136:1114–1119
Treudler R, Orfanos CE, Zouboulis CC (1999) Twenty-eight cases of juvenile-onset Adamantiades-Behçet disease in Germany. Dermatology 199:15–19