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)

Pediatric uveitis: an update

Because of their varied spectrum of clinical presentation and difficulty in management, pediatric uveitis remains a challenge to the ophthalmologist. Variations in clinical presentation, difficulties in eye examination, extended burden of the inflammation over quality of life, limited treatment modalities, risk of amblyopia are the main challenges in the management of pediatric uveitis. Pediatric uveitis is a cause of significant ocular morbidity and severe vision loss is found in 25-33% of such cases. This article summarizes the common causes of uveitis in children with special approach to the evaluation and diagnosis of each clinical entity

Childhood pars planitis; clinical features and outcomes

To evaluate the demographic and clinical features of childhood pars planitis, and to determine the therapeutic and visual outcomes of the disease. Medical records of pediatric patients [less than 16 years of age at diagnosis] with pars planitis and at least 6 months of follow-up who were referred to Labbafinejad Medical Center, Tehran, Iran over a 22 year period were reviewed. Overall, 117 eyes of 61 patients including 51 [83.6%] male subjects were included. Mean age at the time of diagnosis was 7.8 +/- 3.2 [range, 3-16] years. Mean best corrected visual acuity [BCVA] was 0.88 +/- 0.76 logMAR at presentation which improved to 0.39 +/- 0.51 logMAR at final visit [P<0.001]. Endotheliitis was present in 23 [19.6%] eyes and was significantly more prevalent in subjects younger than 9 years [P=0.025]. Cataract formation [41.9%] and cystoid macular edema [19.7%] were the most prevalent complications. Univariate regression analysis showed that better baseline visual acuity [OR=0.38, 95%CI 0.21-0.70, P=0.002], age older than 5 years at disease onset [OR=0.36, 95%CI 0.14-0.9, P=0.029], absence of endotheliitis [OR=0.39, 95%CI 0.15-0.99, P-0.047] and female gender [OR=3.77, 95%CI 1.03-13.93, P=0.046] were significantly associated with final BCVA of 20/40 or better. Childhood pars planitis was much more common among male subjects. Endotheliitis may be a sign of inflammation spillover and is more prevalent in younger patients. Visual prognosis is favorable in most patients with appropriate treatment

Pediatric uveitis

Uveitis is less common in children than in adults, and its diagnosis and management can be particularly challenging. Young children are often asymptomatic either because of inability to express complaints or because of the truly asymptomatic nature of their disease. Even in advanced cases, parents may not be aware of severe visual impairment until the development of externally visible changes such as band keratopathy, strabismus, or leukocoria. Therefore, the diagnosis is often delayed and severe complications may be seen at the time of initial visit. Young children may not be cooperative for a complete ocular examination and subtle findings of intraocular inflammation such as trace cells may be easily missed in the early stages of the disease. Children, in general, tend to have more severe and chronic intraocular inflammation that frequently results in ocular complications and visual loss. In children who present with amblyopia or strabismus, a careful examination is required to rule out uveitis as an underlying cause. Delayed and variable presentations cause a distinct challenge in the diagnosis of uveitis in children, furthermore differential diagnosis also requires awareness of etiologies which are different from adults. There are unique forms of uveitis and masquerade syndromes in this age group, while some entities commonly encountered in adults are rare in children

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.

Endoteliopatía corneal autoinmune como manifestación de uveitis intermedia / Corneal autoimmune endotheliopathy as manifestation of intermediate uveitis in children

Background: Intermediate Uveitis (IU) is an important cause of uveitis in children. It is considered a chronic intraocular inflammation that mainly affects the anterior vitreous and peripheral retina. Pars Planitis is a subtype of IU, consisting of a white opacity that covers the pars plana and ora serrata plus vitreous condensations in the eye. Corneal endothelium disease is a rare clinical finding associated with pars planitis. Objective: Describe the corneal manifestations in IU and its associated treatment between ophthalmology and pediatric rheumatology. Case-report: A 5 years-old boy with autoimmune endotheliopathy and unilateral pars planitis in the right eye. Initially, he was treated topically, but evolved with intraocular complications that required systemic medication. Long-term follow-up was performed, searching for associated systemic diseases, until one of these entities appeared. Conclusion: It is very important to search for inflammation in the anterior vitreous and pars plana in all children with corneal endotheliopathy, considering that an early and integral management of IU could diminish the risk of visual impairment as a complication.

Introducción: La Uveitis Intermedia (UI) es una causa importante de uveitis infantil. Se considera como una inflamación intraocular crónica que afecta principalmente a la retina periférica y vitreo anterior. La Pars Planitis es un subtipo de UI caracterizada por opacidades blanquecinas sobre la pars plana y ora serrata más condensaciones vitreas. La enfermedad del endotelio corneal es un hallazgo clínico infrecuente asociado con la Pars Planitis. Objetivo: Destacar la manifestación corneal de una UI y el tratamiento de la enfermedad entre oftalmólogo y reumatólogo infantil. Caso clínico: Se presenta caso clínico de niño de 5 años de edad con endoteliopatía autoinmune asociada a Pars Planitis unilateral del ojo derecho, que en principio se trató localmente, pero evolucionó con complicaciones intraoculares que requirieron medicación sistémica y se efectuó un seguimiento clínico por varios años buscando enfermedades sistémicas asociadas a UI hasta que ella apareció. Conclusión: Es necesario buscar la presencia de inflamación de pars plana y vitreo en todo niño que se presente con endoteliopatía corneal, considerando que el tratamiento oportuno y manejo integral del paciente con UI puede disminuir el riesgo de pérdida visual asociado a las complicaciones de esta enfermedad.

Pars plana vitrectomy and internal limiting membrane peeling for macular oedema secondary to retinal vein occlusion: a pilot study

<p><b>INTRODUCTION</b>Macular oedema is the main cause of visual impairment following retinal vein occlusion. The purpose of this study was to evaluate the anatomical and functional outcome of pars plana vitrectomy and internal limited membrane (ILM) peeling for macular oedema secondary to retinal vein occlusion.</p><p><b>CLINICAL PICTURE</b>This pilot study is a prospective nonrandomised series of 11 eyes of 11 patients with macular oedema secondary to retinal vein occlusion. The best-corrected visual acuity (BCVA), foveal thickness on optical coherence tomography, fundus fluorescein angiography (FFA) and multifocal electroretinography were evaluated.</p><p><b>TREATMENT AND OUTCOME</b>All 11 patients underwent pars plana vitrectomy with ILM peeling. The mean postoperative follow-up was 13.5 months (range, 1.5 to 24). The mean thickness at the foveal centre decreased from 794 +/- 276 microm preoperatively to 373 +/- 150 microm, 302 +/- 119 microm, 249 +/- 203 microm and 185 +/- 66 microm at 1 week, 1 month, 3 months and the final visit postoperatively, respectively (all P <0.001, paired t- test, compared to preoperative thickness). Postoperative FFA demonstrated markedly reduced leakage in the macular region. At the final visit, BCVA improved 2 lines or more in 72.7% (8/11) of patients and was unchanged in 27.3% (3/11) patients. Complications included cataract in 7 patients and vitreous haemorrhage, recurrence of macular oedema and visual field defect in 1 case each.</p><p><b>CONCLUSION</b>Pars plana vitrectomy and ILM peeling rapidly reduced the macular oedema caused by retinal vein occlusion, with improvement in BCVA.</p>

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.

Clinical Analysis of Pars Planitis with Prominent Snowbank

PURPOSE: To evaluate the clinical characteristics of the intermediate uveitis with prominent snowbank, METHODS: We retrospectively reviewed the records of the patients with intermediate uveitis characterized by the snowbank larger than half a quadrant. RESULTS: Of all 49 patients, 67 eyes, the mean age was 37.3 years. Male patients was 31, and eighteen patients (36.7%) were bilateral. Snowbank was at the inferior in 56 eyes (83.6%), and larger than two quadrant in 16 eyes (23.9%). Mean follow-up was 27 months. Final visual acuity improved in 40 eyes (59.7%), worsened in 4 eyes (6.0%), and more than 0.5 in 51 eyes (76.1%). Complications were cystoid macular edema (23 eyes, 34.3%), retinal detachment (22 eyes, 32.8%), and vitreous hemorrhage (11 eyes, 16.4%). Procedures were barrier laser photocoagulation (45 eyes, 67.2%), pars plana vitrectomy(12 eyes, 17.9%), scleral buckling(2 eyes, 3.0%), cataract surgery (9 eyes, 13.4%), trabeculectomy(6 eyes, 9.6%), and cryopexy (1 eye, 1.5%). Statistically, there was no significant relationship in the final visual acuity and gender, bilaterality, initial visual acuity of 0.5 or above, snowbank larger than two quadrants, and barrier laser photocoagulation. However, pars plana vitrectomy showed a significant relationship (p<0.001). CONCLUSIONS: Intermediate uveitis with prominent snowbank seems to show the similar clinical prognosis to generally-reported intermediate uveitis, and the prognosis of pars plana vitrectomy is good.

Removal of Silicone Oil Using Sutureless Corneal Incisions in Aphakia

PURPOSE: To evaluate the efficacy and safety of silicone oil (SO) removal through sutureless corneal incisions in aphakia. METHODS: We analyzed the records of the patients who underwent SO removal using clear corneal incisions in aphakia. RESULTS: Of 43 patients, there were 43 eyes, and 26 were male. The mean age was 41.5 years and followup period was 19.1 months. Indications for SO injection were ocular trauma in 15 eyes, macular hole retinal detachment in 3 eyes, proliferative diabetic retinopathy in 2 eyes, giant retinal tear in 2 eyes, pars planitis in 1 eye and other complex retinal detachment including proliferative vitreoretinopathy in 20 eyes. The viscosity of SO were 1,300 centistroke (cs) in 6 eyes and 5,700 cs in 37 eyes. Postoperative complications included emulsified silicone droplets in 2 eyes (4.7%), temporary increase of intraocular pressure in 5 eyes (11.6%) and recurrent retinal detachment in 2 eyes (4.7%). CONCLUSIONS: Sutureless corneal incisions in aphakia might be brief, effective and safe method to remove SO.

Resultados de la vitrectomia combinada con implante de válvula de Ahmed e inserción del tubo vía pars plana / Results of the combined vitrectomy with it implant of ahmed and insert of the tube pathway pars plana

Evaluar los resultados de la vitrectomia combinada con implante de válvula de Ahmed e inserción del tubo vía pars plana en el manejo de glaucomas complicados. Se evaluaron respectivamente los resultados de vitrectomía combinada con implante de válvula de Ahmed e inserción del tubo vía pars plana dentro de una serie de 40 implantes valvulares realizados entre enero 1997 y julio 2000 en el Servicio de Oftalmología del Centro Clínico Docente la Trinidad. Se evaluó el "éxito quirúrgico", definido como: total, con una presión intraocular < 21 mmHg y >5 mmHg sin uso de medicación; parcial, igual al criterio anterior pero con uso de medicación; y fracaso, con una presión intraocular >21 mmHg aún con el uso de medicación. Otros parámetros evaluados fueron: mejor agudeza visual corregida (MAVC), presión intraocular, número de medicamentos y complicaciones asociadas al procedimiento. En 12 ojos de pacientes (Edad media 53,2 ñ 14,7 años y presión intraocular preoperatoria de 33,8 ñ 10,2 mmHg), se realizó vitrectomía combinada con implante de válvula de Ahmed e inserción del tubo vía pars plana. Durante el período promedio de seguimiento de 11,5 ñ 13,3 meses, se alcanzó el éxito total en 50,04 por ciento, parcial en 33,36 por ciento y fracaso en 16,6 por ciento de los casos, con una presión intraocular media postoperatoria de 15,3ñ2,9 mmHg, con una diferencia significativa en relación a la presión intraocular preoperatoria (p < 0,001) (ANOVA). La media de medicamentos en el preoperatorio fue 2,08 ñ 0,9 y en el posoperatorio 0,8 ñ 0,8, (p<0,01) (ANOVA). La MAVC mejoró en un 50 por ciento, se mantuvo en 41,6 por ciento y empeoró en el 8,3 por ciento de los casos. Se observaron complicaciones en un 25 por ciento de los casos. La vitrectomía combinada con implante de válvula de Ahmed e inserción del tubo vía pars plana constituye una opción válida en el manejo de glaucomas complicados

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.

Vitrectomia em pacientes com pars planitis e edema cístico macular: quando indicá-la / Vitrectomy in cystoid macular edema due to prs planitis

O edema cístico macular é uma das complicaçöes mais temíveis da pars planite, frequentemente responsável por severo e definitivo déficit visual. A importância da vitrectomia no tratamento de muitas uveítes crônicas tem sido amplamente demonstrada. Já a sua eficácia na regressäo do edema cístico macular é um assunto mais recente e polêmico. Trata-se do primeiro estudo realizado no Brasil sobre a eficácia da vitrectomia no controle do edema cístico macular associado à pars planits. Sete pacientes com edema cístico macular crônico, rebelde a todas as tentativas terapêuticas, foram submetidos à vitrectomia via pars plana e observados, sequencialmente, por no mínimo 20 e no máximo 74 meses. O edema cístico macular foi responsável pela decesäo cirúrgica. A literatura foi revisada e discutida

Pars planite; consideraçöes sobre tratamento e relato de um caso / Pars planite; considerations about treatment and a case report

Os autores relatam um caso de uveíte intermediária (pars planite) num paciente de 10 anos de idade submetido a tratamento clínico (corticoterapia tópica e antiinflamatório näo hormonal tópico por 14 meses) que persistiu com a mesma acuidade visual inicial. Os autores ressaltam a importância do cuidado com o tratamento, no sentido de evitar catarata, glaucoma e outras complicaçöes devido ao uso abusivo de esteróides (fator iatrogênico)

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.

Uveíte intermediária (pars planite) e endoteliopatia corneana auto imune (estudo de 4 casos) - parte II / Intermediate uveitis (pars planitis) and autoimmune corneal endotheliopathy (study of 4 cases) - part II

Os autores estudam 4 casos de uveíte intermediária bilateral, em crianças entre 5 e 8 anos de idade, com a presença de associaçäo de endoteliopatia corneana com uma exsudaçäo na periferia inferior da retina.

Pars Plana Vitrectomy in Pars Planitis and Posterior Uveitis

This study was undertaken to evaluate the effectiveness of pars plana vitrectomy in pars planitis and posterior uveitis. We performed pars plana vitrectomies in consecutive series of 31 eyes with pars planitis and posterior uveitis that were complicated with vitreous opacities, epiretinal membrane formation, tractional retinal detachment and posterior subcapsular cataract. Postoperatively improvement of visual acuity, 2 lines or more in Snellen chart, was noted in 19 eyes(61.2%) with a mean follow-up of 21 months. The inflammatory cells were not visible in anterior chamber or anterior vitreous after 1 month thereafter. In three patients, however, the postoperative visual acuities were worSe due to preoperatively combined cystoid macular edema, macular pucker and tractional retinal detachment. We believe early pars plana vitrectomy before the formation of epiretinal membrane is an important factor in minimizing and postoperative complications.

Treatment of Complicated Retinal Detachments by Intraoperative Use of Perfluorphenantenanthrene Liquid

We have applied the intraoperative use of Perfluorophenanthrene (C14F24) liquid in 19 eyes of complicated retinal detachment surgery in 19 patients since November 1990 to October 1991. The vast majority of case of retinal detachment was trauma (9 eyes) and uveitis including pars planitis (6 eyes) remainders were juvenile retinoschisis, cataract surgery, myopIa, diabetes one eye each. The grade-D of proliferative change was found in 9 eyes (D1 3 eyes, D2 3 eyes, D3 3 eyes) and 8 eyes belong to over grade-C2 (C2 4 eyes, C3 4 eyes). Multiple anterior retinal tears were found in two. Giant retinal tear was noticed in 5 eyes and the other one was made on therapeutic purpose. Intraoperative reattachment was obtained in all eyes. The follow-up periods were 6 or more (mean 9.1) months. At last follow-up, the retina was attached in 12 eyes (63%), partially attached in 2 (10%) and redetached in 5 (26%). Visual acuity was improved or same in 12 eyes (63%), became worse in 7(37%). Visual acuity of 0.02 or better was obtained in 12(63%) eyes and 3(16%) saw 0.1 or better. Perfluorophenanthrene liquid was thought as non-toxic, heavy biomaterial and effective to treat the complicated retinal detachments.

Pars Plana Vitrectomy in Pars Planitis and Posterior Uveitis

This study was undertaken to evaluate the effectiveness of pars plana vitrectomy in pars planitis and posterior uveitis. We performed pars plana vitrectomies in consecutive series of 31 eyes with pars planitis and posterior uveitis that were complicated with vitreous opacities, epiretinal membrane formation, tractional retinal detachment and posterior subcapsuIar cataract. Postoperatively improvement of visual acuity, 2 lines or more in Snellen chart, was noted in 19 eyes (61.2%) with a mean follow-up of 21 months. The inflammatory cells were not visible in anterior chamber or anterior vitreous after 1 month thereafter. In three patients, however, the postoperative visual acuities were worse due to preoperatively combined cystoid macular edema, macular pucker and tractional retinal detachment. We believe early pars plana vitrectomy before the formation of epiretinal membrane is an important factor in minimizing and postoperative complications.