Pars Planitis en la infancia / Pars Planitis in childhood

Objetivo: Evaluar la respuesta al tratamiento con corticoides e inmunomoduladores en niños con pars planitis. Materiales y método: Se realiza un estudio retrospectivo y observacional de nueve historias clínicas de pacientes con diagnóstico de pars planitis atendidos en el servicio de oftalmología del Hospital de Pediatría Juan P. Garrahan desde el año 2010. Resultados: De los nueve pacientes 6 eran niños y 3 niñas. El motivo de consulta principal fue disminución de la visión. La mayoría de los pacientes fueron derivados por otros oftalmólogos para tratamiento. El 100% sufrió afectación ocular bilateral. Las complicaciones fueron: catarata, queratopatía en banda, hipertensión ocular y edema macular cistoide. El 100% de los pacientes recibió tratamiento con corticoides por vía oral e inmunomoduladores. A algunos se les efectuó inyecciones de triamcinolona subtenoniana y criocoagulación. Conclusiones: con el tratamiento con prednisona e inmunomoduladores se logró mejoría en la agudeza visual en 15 ojos y 3 ojos mantuvieron igual agudeza visual. La pars planitis es una patología crónica con un pronóstico visual reservado que requiere de un seguimiento estrecho y tratamiento prolongado por parte de un equipo interdisciplinario (AU)

Objective: To assess response to steroid and immunomodulating treatment in children with pars planitis. Material and methods: A retrospective observational study was conducted reviewing nine clinical charts of children with a diagnosis of pars planitis seen at the Department of Ophthalmology of the Pediatric Hospital Juan P. Garrahan since 2010. Results: Of nine patients, six were boys and three were girls. Main complaint was loss of vision. The majority of patients were referred to our hospital by other ophthalmologists for treatment. All children had bilateral eye involvement. Complications observed were: cataracts, band keratopathy, ocular hypertension, and cystoid macular edema. All patients received oral steroids and immunomodulating treatment. In some subtenonian injection of triamcinolone and cryocoagulation was performed. Conclusions: Prednisone and immunomodulating treatment resulted in an improvement of visual acuity in 15 eyes and three eyes visual acuity remained unchanged. Pars planitis is a chronic disease with an uncertain visual prognosis that requires close follow-up and prolonged treatment by an interdisciplinary team (AU)

Intermediate uveitis.

Intermediate uveitis (IU) is described as inflammation in the anterior vitreous, ciliary body and the peripheral retina. In the Standardization of Uveitis Nomenclature (SUN) working group's international workshop for reporting clinical data the consensus reached was that the term IU should be used for that subset of uveitis where the vitreous is the major site of the inflammation and if there is an associated infection (for example, Lyme disease) or systemic disease (for example, sarcoidosis). The diagnostic term pars planitis should be used only for that subset of IU where there is snow bank or snowball formation occurring in the absence of an associated infection or systemic disease (that is, “idiopathic”). This article discusses the clinical features, etiology, pathogenesis, investigations and treatment of IU.

Clinical Characteristics and Treatments of Intermediate Uveitis

PURPOSE: To investigate the clinical characteristics and treatment of intermediate uveitis under new diagnostic standards. METHODS: Medical records of patients diagnosed with pars planitis or intermediate uveitis were followed for more than 6 months, and retrospectively reviewed. RESULTS: A total of 90 patients and 117 eyes were enrolled in the study. The mean age was 40.1 years, and the mean follow-up period was 43.0 months. Thirty percent of cases were bilateral. The most common initial symptom was decreased visual acuity. Snowbank was detected in 39.3%, snowballs in 15.4%, vitritis in 96.6%, and vasculitis in 56.4%. Common complications includedcystoid macular edema (57.3%), cataracts (43.6%), and epiretinal membrane (36.8%). Therapies included topical steroids (82.9% of cases), posterior sub-Tenon steroid injection (45.3% of cases), systemic steroid administration (67.8% of cases), and immunosuppressants (28.7% of cases). Vitrectomy was performed in 11.1% of patients due to complications such as epiretinal membrane and traction retinal detachment. The mean initial and final visual acuities were 0.67 and 0.74, respectively. CONCLUSIONS: The patients in this study experienced various courses of symptoms that required different treatment plans. Future investigations may corroborate these results.

Secondary Giant Retinal Cyst

PURPOSE: Giant retinal cyst is formed by a localized and circumscribed splitting of the retina into two layers. It may often be confused with retinal detachment. We describe three cases of giant retinal cysts associated with retinal detachment associated with uveitis, and proliferative diabetic retinopathy. METHODS: A retrospective, observational case series. RESULTS: Two cases of giant retinal cyst were associated with uveitis: one detected during pars plana vitrectomy for total retinal detachment associated with chronic uveitis, and the other detected after scleral buckling procedure for retinal detachment associated with pars planitis. These cysts completely disappeared following drainage of fluid and laser photocoagulation to the flattened cyst. A case of retinal cyst secondary to proliferative diabetic retinopathy and vitreous hemorrhage was observed to be free of complication and progression without any surgical intervention for 9 months. CONCLUSIONS: Giant retinal cyst may result from intraretinal degenerative change caused by retinal capillary ischemia, vitreous traction and intraretinal leakage from the neovascularization. The cyst is considered to be stable without treatment in some cases, and in others it may be resolved with pars plana vitrectomy, fluid drainage and laser photocoagulation.

Results of Surgical Treatment of Complicated Pars Planitis

We performed pars plana vitrectomy on 19 patients with pars planitis with its complications like vitreous opacity and retinal detachment.There were 16 males and 3 females with a mean age of 42.8 years.The follow-up ranged from 6 to 122 months with a mean of 25 months.Following surgery, final visual acuity was improved or unchanged in the 78.9 percent of patients.Eight cases (42.1%)showed improved vision, seven patients (36.8%) showed no change and four cases (21.1%)worse vision.Retinal detachment was successfully repaired in 17 patients and two eyes failed anatomically due to the proliferative vitreoretinopathy.The main factor favoring functional success was the short duration from the onset to the time of vitrectomy.It might be concluded that vitrectomy should be performed in the vision threatening stages on the patients with complicated pars planitis.

Spontaneous Separation of Epiretinal Membrane in Young Adult

In children and young adults, secondary epiretinal membranes after ocular trauma, pars planitis, ocular toxocariasis, and Coat's disease are common and spontaneous separation occurs in a relatively higher rate with improvement in visual acuity than elderly patients. In a 31-year-old man with pars planitis, diffuse epiretinal membrane in the macula became thinner during systemic and topical steroid therapy. Two years after treatment, the preretinal membrane spontaneously separated from the macula to the inferior temporal arcade, and visual acuity improved from 0.15 to 1.0. The authors reviewed the available literatures regarding the possible mechanisms for the spontaneous separation ofepiretinal membrane.

The Effects of Cryotherapy in Pars Planitis

Pars planitis is characterized by an inferior vitreous opacification with vitreous exudation and organization. Although it has been called a benign process. it may lead to recurrent exacerba tions and remissions with many ocular complications. The response to corticosteroid treatment is seemingly good. However, many ocular complications such as posterior subcapsular cataract. vitreous opacity and cystoid macular edema were developed. This study was undertaken to evaluate the effectiveness of cryopexy on severe cases not responding to corticosteroid therapy. We reviewed a consecutive series of 9 eyes in the nine patients with pars planitis that had been treated with cryopexy and followed for a meridian of 23 months. In majority of cases, the inflammatory cells were not visible in anterior chamber and no increase of inflammatory cells in the anterior viterous after 2 months except 2 cases who were recurred on the other sides of the same eye. The improvement of visual acuity was rather good without significant side effects.

Vitrectomy in Complicated Pars Planitis

Consecutive twelve patients' twelve eyes with complicated pars planitis underwent pars plana vitrectomy at our center in the period from January 1988 to December 1990. Patients' ages ranged from 24 to 60(mean 39.9)years and all were male. Nine patients had histories of topical or systemic steroid therapy and at the time of surgery, all eyes were quiet from active inflammation. With various degrees of vitreal opacities, five eyes had macular pucker or membrane only and in other seven eyes, retinal detachments of either tractional or tractional-rhegmatogenous origin were arisen. In the later group, macular hole was associated in two eyes. Surgical procedures combined were membrane peeling(five eyes), scleral buckling(ten eyes), fluid/air-gas exchange(eight eyes), lensectomy(two eyes) and photocoagulation(two eyes). During the follow-up period ranged from four to twenty-one(mean 7.75)months after first operations, the uveitis recurred or continued to be activated in four eyes and as a complication, retinal detachment occurred in two eyes which had macular pucker only preoperatively. One refused reoperation and the other was reattached successfully by second operation. Final visual acuities were improved in eight eyes, stationary in one and worsen in three. The causes of worsen vision were retinal detachment, macular edema and macular slanting by buckle respectively. Preoperatively, the majority of eyes(10 eyes: 84%) had less than 0.09 vision and postoperative vision turned over better than 0.09 in 7 eyes(59%). Although we did not confirm extinguished therapeutic effects of vitrectomy on the pars planitis perse, our results revealed some positve role of surgical intervention in the complicated pars planitis.