Abstrait

Complications of juvenile uveitis

Alok Bahl, Sohar Nicolette

The International Uveitis Study Group (IUSG) and the Standardisation of Uveitis Nomenclature Working Group (SUN Working Group) have helped define and classify uveitis and reach a global consensus on descriptors and the grading of inflammation. A readily available history taking questionnaire helps to name and mesh the probable uveitic entity, thereby ordering specific investigations tailored to help diagnose a uveitic entity in the most cost effective way.

There are varied uveitic entities that are common in different age groups like infants, toddlers, school children and adolescents, with Juvenile Idiopathic Arthritis Associated Uveitis (JIA-U) being the most common. The knowledge of risk factors for developing uveitis in Juvenile Idiopathic Arthritis (JIA) and poor prognostic indicators has helped in developing screening guidelines.

The better understanding of the pathogenesis of various entities of juvenile uveitis including autoimmunity and genetic associations improved the management of these conditions. There are routine laboratory investigations for all cases and specific ones to diagnose and confirm certain entities.

The main ocular complications of juvenile uveitis include posterior synechiae, cataract, glaucoma, vitreous haze, Cystoid Macular Oedema (CMO), band keratopathy, epiretinal membrane, hypotony and phthisis bulbi.

Corticosteroids usually are the first line of treatment, followed by the use of Disease Modifying AntiRheumatic Drugs (DMARD) and then biologic agents to control inflammation. The latter 2 groups of drugs have also played a role as corticosteroid sparing agents as they help control the inflammation through different mechanisms. Periocular steroid injections and intravitreal dexamethasone implants (Ozurdex) have helped to decrease the systemic side effects of corticosteroids in children.

Several factors should be considered in the surgical management of complications of juvenile uveitis, including the risk of irreversible amblyopia, patient age, degree of inflammation, preoperative visual acuity and current therapy. Judicious perioperative use of topical and systemic corticosteroids with addition of immunosuppression leads to improved outcomes. Close collaboration between the ophthalmologist and the treating paediatric rheumatologist is of extreme importance to ensure a successful surgical outcome.