Uveitis in children: Epidemiological, clinical and prognostic characteristics.

PURPOSE: The purpose of this study is to describe the characteristics and prognostic factors of pediatric uveitis in a French university referral hospital. METHODS: We performed a retrospective study of all cases of all pediatric uveitis seen at our institution over a 7-year period. RESULTS: A total of 141 eyes of 86 children were included. The mean age was 10.7 years, and 61.6% were girls. The uveitis was bilateral in 64.0% of cases. Anterior uveitis (41.0%) and intermediate uveitis (32.0%) were the most frequent forms. The most frequent etiologies were idiopathic (27.9%), juvenile idiopathic arthritis (25.6%) and pars planitis (18.6%). During the follow-up period, systemic corticosteroids were received by 43.0% of children, immunosuppressive drugs by 31.4% and biological agents by 18.6%. At the final examination, complications were present in 67.0% of patients: 18.0% had cataracts, and 11.3% had intraocular hypertension. Posterior synechiae were present in 27.6% of eyes, optic disc edema in 10.5% and macular edema in 16.2%. At the last visit, visual acuity was better than 20/200 in 97.0% of cases. The presence of band keratopathy, cataract or glaucoma was an independent predictor of impaired visual outcomes at follow-up. CONCLUSION: Juvenile idiopathic arthritis is one of the most frequent and severe pediatric uveitides. Close monitoring and early treatment could prevent complications.

[Descemet's membrane detachment after phacoemulsification: Series of 9 cases]. / Décollement descemétique post-phakoémulsification : à propos de 9 cas.

PURPOSE: Descemet's membrane detachment (DMD) is a rare but potentially serious complication of cataract surgery. Although there are no consensual guidelines regarding the diagnosis or treatment of DMD, incorrect treatment may result in irreversible corneal changes with visual sequellae. The purpose of our study is to describe the diagnosis and treatment of DMD. METHODS: We report a series of 9 cases of DMD, their diagnosis, treatment and outcomes. We tested the HELP protocol retrospectively against our 9 real-life cases. RESULTS: Two cases recovered with simple medical management, 4 required air-bubble descemetopexy, and three required keratoplasty. Our study revealed that the main factor associated with poor outcomes is late diagnosis and management. CONCLUSION: Our series illustrates the importance of proactive management and timely diagnosis by performing anterior segment OCT in the setting of persistent postoperative corneal edema.

[Leber-Coats' disease: A retrospective study of 10 patients]. / Maladie de Leber-Coats : étude rétrospective sur 10 cas.

INTRODUCTION: Retrospective study analyzing clinical characteristics and treatment of children affected by Leber-Coats' disease. METHOD: Children with Leber-Coats' disease seen in Edouard-Herriot Hospital, Lyon, between January 2004 and September 2013 were included. The following clinical characteristics were reported: sex, age at diagnosis, presenting symptom, Shields' stage, treatment used, and visual outcomes. RESULTS: Ten children were included in our study. Mean age at diagnosis was 5.5 years. The disease was unilateral in 9/10 cases. The presenting symptom was loss of vision in 7/10 cases, strabismus in 3/10 cases, and microphthalmos in 1 case. The diagnosis was made fortuitously during a follow-up of familial congenital cataract in 2 patients. No cases of leukocoria were seen. Shields' stages were distributed as follows: stage 1, 2A and 2B: 1 case each, stage 3A1: 7 cases, stage>3A1: no cases. Laser photocoagulation was used up to stage 2B, combined with cryotherapy in stage 3A. Stage 1 and 2A were associated with relatively good final visual acuity. Significant macular lipid exudate (stage>2A) was associated with a worse prognosis. CONCLUSION: These epidemiological data help us to better characterize these patients' prognosis. Early diagnosis seems to improve visual outcomes.

[Cytomegalovirus research using polymerase chain reaction in Posner-Schlossman syndrome]. / Intérêt de la recherche du cytomégalovirus par polymerase chain reaction dans le syndrome de Posner-Schlossman.

PURPOSE: To investigate the possible association between cytomegalovirus (CMV) infection and Posner-Schlossman syndrome using PCR. To evaluate the clinical effect of valganciclovir treatment. PATIENTS AND METHODS: Patients with anterior uveitis associated with suspected Posner-Schlossman syndrome had their aqueous humor prospectively analyzed for viral deoxyribonucleic acid by HXFL4 gene detection using quantitative real-time PCR. RESULTS: Seven patients (two females and five males from 15 to 56 years old) with clinical signs of Posner-Schlossman syndrome (anterior nongranulomatous hypertensive uveitis with anterior chamber cells, central keratic precipitates, anisocoria, without iris atrophy) were tested. Examinations of the aqueous humor by polymerase chain reaction demonstrated CMV-DNA in five patients and were negative for other herpes viruses in all patients. Two patients were treated with oral antiviral therapy (valganciclovir). Relapses occurred in all cases after cessation of therapy. DISCUSSION: Aqueous humor analysis by PCR is useful in differentiating between CMV and other herpes viruses and in making a positive etiological diagnosis in anterior hypertensive uveitis. Valganciclovir may be effective in treating CMV anterior uveitis, but its exact role should be determined in larger studies with a longer follow-up. CONCLUSION: Cytomegalovirus detection in aqueous humor using polymerase chain reaction is useful in the management of patients with Posner-Schlossman syndrome.