Pediatric Pars Planitis: A Review.

PURPOSE: To provide an overview of pediatric pars planitis. METHODS: Narrative literature review. RESULTS: Pars planitis refers to the idiopathic subset of intermediate uveitis in which there is vitritis along with snowball or snowbank formation occurring in the absence of an associated infection or systemic disease. It is thought to be a T-cell mediated disease with a genetic predisposition. Pars planitis accounts for 5-26.7% of pediatric uveitis cases. Presentation is commonly bilateral but asymmetric, often with insidious onset of floaters and blurred vision. Although pars planitis is known to be a benign form of uveitis in most cases, severe complications secondary to chronic inflammation may arise, with cystoid macular edema being the most common cause of visual morbidity. Mild vitritis in the absence of symptoms, vision loss, or macular edema may be observed. Patients with severe vitritis and/or associated vision-threatening complications require prompt aggressive treatment. A stepladder approach including corticosteroids, immunosuppressive agents, anti­tumor necrosis factor­alpha and pars plana vitrectomy and/or laser photocoagulation is the most commonly used method for treatment of pars planitis. CONCLUSION: Timely diagnosis and adequate treatment of pediatric pars planitis and associated complications are crucial in order to improve visual outcomes.

[Clinical and epidemiological features and HLA association in patients with pars planitis]. / Características clínicas, epidemiológicas y asociación con el sistema HLA en pacientes con pars planitis.

BACKGROUND AND OBJECTIVES: Epidemiological studies on North American patients reported an association between HLA DR15 and pars planitis. This association has not been studied in the Spanish population. The objectives of the present study were to describe the clinical and epidemiological features of patients with pars planitis diagnosed in our hospital as well as the prevalence of multiple sclerosis and HLA class I and II. PATIENTS AND METHODS: Twenty four patients with pars planitis were identified among 226 patients with uveitis diagnosed in the Ophtahlmology Department of our center from January 1992 to October 2006. Twenty four patients and 194 healthy controls underwent HLA A, B and DR genotyping. RESULTS: The most frequent complication was cystic macular edema. Most patients needed many medical treatments. No statistical association was found between pars planitis and HLA. CONCLUSIONS: Epidemiological data were consistent with previously reported studies. There appears to be no association between the occurrence of pars planitis and HLA DR 15 or other known HLA genotypes in Spanish patients. However, the small sample size could have limited the power of this study.

Complications in Intermediate Uveitis: Prevalence, Time of Onset, and Effects on Vision in Short-Term and Long-Term Follow-Up.

Purpose: 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. Methods: A retrospective cohort study of patients with IU who had a minimal follow-up of one year. Results: 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. Conclusion: 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.

Pars planitis: a 20-year study of incidence, clinical features, and outcomes.

PURPOSE: To measure the incidence of pars planitis in a community-based population and to report clinical features, complications, and visual prognosis. DESIGN: Population-based, retrospective, 20-year cohort study. METHODS: Multicenter study using the Rochester Epidemiology Project medical records linkage system, which allows analysis of almost all patients within Olmsted County, Minnesota, with a given medical condition. Databases were searched to identify all patients with pars planitis from January 1, 1985 through December 31, 2004. Forty-six eyes of 25 patients were evaluated. RESULTS: Mean follow-up was 14.3 years. The incidence of pars planitis was 2.077 per 100,000 persons (95% confidence interval [CI], 1.43 to 2.62). The most common complications were epiretinal membrane (ERM) in 17 eyes (36%), cataract in 14 eyes (30.4%), and cystoid macular edema (CME) in 12 eyes (26.1%). Mean visual acuity after 10 years of follow-up was 20/30, with 18 of 24 patients maintaining a visual acuity of 20/40 or better. One-third of patients maintained normal visual acuity without requiring treatment. CONCLUSIONS: The visual prognosis of pars planitis is relatively good, with 75% of patients maintaining a visual acuity of 20/40 or better after 10 years. Many patients with mild disease do not require treatment. A subset of patients, however, experience severe disease with severe vision loss despite treatment. The rate of smoking and multiple sclerosis in patients with pars planitis is much higher than that of the general population.

Pars planitis in children: epidemiologic, clinical, and therapeutic characteristics.

PURPOSE: To report the demographics and clinical characteristics, therapy logarithm, and prognosis of children with pars planitis. PATIENTS AND METHODS: The medical records were reviewed of all patients diagnosed with pars planitis between June 1995 and December 2005 in the Department of Pediatric Ophthalmology at Hospital Universitario La Paz, Madrid, Spain. A retrospective, descriptive, and longitudinal study of 30 eyes in 16 children was performed. RESULTS: Pars planitis was bilateral in 87.5% and more frequent in males (68.8%). Average age at onset was 9.2 years. The main ophthalmologic findings recorded were snowballs (96.7%) and vitritis (93.3%). Cataract formation was the most prevalent complication (36.7%). Mean initial and final best-corrected visual acuities were 0.640 and 0.840, respectively. Periocular corticosteroids were used in 33.3% of cases and cryotherapy or laser photocoagulation in 16.7%. Complications requiring surgical management occurred in 4 eyes (13.3%). CONCLUSION: Pars planitis treated with adequate medical and surgical procedures has a good prognosis in most cases.

The appearance of pars planitis in multiple sclerosis.

The aim of the study was to investigate the clinical association of multiple sclerosis and pars planitis (or intermediate uveitis), as well as to determine the incidence of pars planitis in multiple sclerosis patients. During the period of one year authors examined 42 patients with multiple sclerosis divided into two groups. First group consisted of 23 patients with history of optic neuritis and the second group consisted of 19 patients who have never had optic neuritis. The mean age of patients in the first group was 31.7 +/- 5.1 years and in the second group 29.1 +/- 8.1 years. Pars planitis was found in 12 patients with multiple sclerosis. Age, sex and degree of neurological disability had no influence on the appearance of pars planitis. Although optic neuritis is considered to be the most common ocular manifestation of multiple sclerosis, the significant number of patients with multiple sclerosis has pars planitis.

Pars planitis: epidemiology, treatment, and association with multiple sclerosis.

During retrospective and prospective studies, we attempted to determine the clinical characteristics, treatment, and visual outcome of patients with pars planitis and to evaluate the association between pars planitis and multiple sclerosis (MS). The retrospective study included 44 patients with pars planitis, who had been examined between October 1986 and January 1999. We analyzed age, sex, visual acuity (VA), median follow-up time, and medical and surgical treatments. The prospective study, which included 21 consecutive patients with pars planitis, was performed to determine the presence of MS. In the retrospective study, the mean patient age was 22.4 years (SD +/- 11.5) and the median follow-up was 34.9 months (SD +/- 27.2). Complications included macular edema (47.7%), vitreous opacities (38.6%), papillitis (38.6%), vasculitis (36.4%), and cataract (20.5%). Forty patients (90.9%) had a final bilateral VA better than 20/40. In the prospective study, magnetic resonance imaging (MRI) was performed. Demyelinating lesions were found in 10 (47.6%) of the 21 patients and relapsing-remitting clinically definite MS was diagnosed in seven (33.3%). With the exception of age, no significantly statistical differences were observed when the visual prognosis and the clinical and epidemiologic characteristics were compared between the two groups of patients with and without associated MS; a diagnosis of MS was more frequently made in patients over 25 years of age. With appropriate treatment, patients with pars planitis have a good visual prognosis. Because the presence of demyelinating lesions seems to be high among patients with pars planitis, MRI should be considered, especially in patients over 25 years of age.

Pars planitis in the Mexican Mestizo population: ocular findings, treatment, and visual outcome.

PURPOSE: To describe the clinical manifestations of classic pars planitis (CPP) in Mexican patients. We report here the most frequent complications, medical and surgical treatment, and visual prognosis. MATERIAL AND METHODS: A retrospective, descriptive case series examined the clinical features, complications, and treatment (medical and surgical) of CPP patients seen at the Inflammatory Eye Disease Clinic from January 1990 to September 1999. RESULTS: One hundred and sixty patients met inclusion criteria for the study. Mean age at presentation was 10 years and males were more frequently affected. Both eyes were affected in 84.4% of the cases. The most frequent complaint was decreased visual acuity. Initial visual acuity (VA) ranged from no light perception to 20/20 (mean 20/50), and mean final VA was 20/30. The most frequent clinical manifestations were vitritis (99.7%), snowballs (99.3%), retinal vasculitis (89.2%), and snowbanks (63.1%). The most common complications were cystoid macular edema (63.4%) and cataract (47.5%). Periocular corticosteroids were used in 97.5% of cases, systemic corticosteroids in 68.1%, and other immunosuppressive drugs in 21.3%. CONCLUSIONS: CPP in the Mexican population is more frequent in males and usually presents in patients less than 14 years of age. It is typically bilateral, and the most common symptom is decreased visual acuity. The most important clinical findings are located in the vitreous and retina. Cataract and cystoid macular edema are the most frequent complications. Treatment comprises periocular and systemic corticosteroids or other immunosuppressive drugs.

Pars planitis: epidemiology and clinical outcome in a large community hospital in Mexico City.

Medical records of 51 patients with a diagnosis of pars planitis (97 eyes) were reviewed. Based upon the severity of vitreous inflammation, in 34 eyes (35%) the condition was classified as mild, in 38 (39%) as moderate, and in 25 eyes (26%) as severe. Vascular sheathing was present in 51 eyes (53%), snowballs in 42 (43%), snowbanks in 29 (30%), cataract in 19 (20%), cystoid macular edema in 26 (27%), retinal detachment in 4 (4%) and glaucoma in 3 (3%) eyes. Treatment consisted of prednisone and periocular injections of deposteroids or immunosuppressive agents; 13 patients required surgery for retinal repair, glaucoma, vitreous opacities or cataract. After treatment the visual acuity improved in 58% of the eyes, did not change in 33%, and worsened in 9%.

Vitreous hemorrhage is a common complication of pediatric pars planitis.

OBJECTIVE: To report the prevalence of vitreous hemorrhage in pars planitis and to compare the prevalence of hemorrhage for children and adults with the disease. DESIGN: A retrospective, cross-sectional observational study. PARTICIPANTS: One hundred eighteen consecutive patients with pars planitis who were evaluated at the Oregon Health and Science University Uveitis Clinic between September 1985 and April 2000. METHOD: A review of clinical records. MAIN OUTCOME MEASURES: For all patients, we recorded presence or absence of vitreous hemorrhage, as well as laterality and cause. Children were defined as being age 16 years or younger at diagnosis, and adults were defined as being aged 17 years or older at diagnosis. RESULTS: Fourteen percent of patients with pars planitis experienced vitreous hemorrhage. Persons with hemorrhage were significantly younger at the time of disease diagnosis than persons without hemorrhage (P = 0.040). The difference in prevalence of vitreous hemorrhage between children (28%) and adults (6%) was statistically significant (P = 0.003). The difference in prevalence of hemorrhage as a presenting feature between children (20%) and adults (1%) was also statistically significant (P = 0.001). CONCLUSIONS: Children with pars planitis are more likely than adults to experience vitreous hemorrhage. Pars planitis should be considered in the differential diagnosis of pediatric vitreous hemorrhage.