Recommendations for the Management of Uveitis Associated With Juvenile Idiopathic Arthritis: The Czech and Slovak adaptation of SHARE Initiative.

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and uveitis is its most important extra-articular manifestation. Evidence-based recommendations are available only to a limited extent and therefore JIA associated uveitis management is mostly based on physicians experience. Consequently, treatment practices differ widely, both nationally and internationally. Therefore, an effort to optimize and publish recommendations for the care of children and young adults with rheumatic diseases was launched in 2012 as part of the international project SHARE (Single Hub and Access Point for Pediatric Rheumatology in Europe) to facilitate clinical practice for paediatricians and (paediatric) rheumatologists. The aim of this work was to translate published international SHARE recommendations for the diagnosis and treatment of JIA associated uveitis and to adapt them for use in the Czech and Slovak Republics. International recommendations were developed according to the standard methodology of the European League against Rheumatism (EULAR) by a group of nine experienced paediatric rheumatologists and three experts in ophthalmology. It was based on a systematic literature review and evaluated in the form of an online survey and subsequently discussed using a nominal group technique. Recommendations were accepted if > 80% agreement was reached (including all three ophthalmologists). A total of 22 SHARE recommendations were accepted: 3 on diagnosis, 5 on disease activity assessment, 12 on treatment and 2 on future recommendations. Translation of the original text was updated and modified with data specific to the czech and slovak health care systems and supplemented with a proposal for a protocol of ophthalmological dispensarization of paediatric JIA patients and a treatment algorithm for JIA associated uveitis. Conclusion: The aim of the SHARE initiative is to improve and standardize care for paediatric patients with rheumatic diseases across Europe. Therefore, recommendations for the diagnosis and treatment of JIA-associated uveitis have been formulated based on the evidence and agreement of leading European experts in this field.

Economic values for health and feed efficiency traits of dual-purpose cattle in marginal areas.

Economic values of clinical mastitis, claw disease, and feed efficiency traits along with 16 additional production and functional traits were estimated for the dairy population of the Slovak Pinzgau breed using a bioeconomic approach. In the cow-calf population (suckler cow population) of the same breed, the economic values of feed efficiency traits along with 15 further production and functional traits were calculated. The marginal economic values of clinical mastitis and claw disease incidence in the dairy system were -€ 70.65 and -€ 26.73 per case per cow and year, respectively. The marginal economic values for residual feed intake were -€ 55.15 and -€ 54.64/kg of dry matter per day for cows and breeding heifers in the dairy system and -€ 20.45, -€ 11.30, and -€ 6.04/kg of dry matter per day for cows, breeding heifers, and fattened animals in the cow-calf system, respectively, all expressed per cow and year. The sums of the relative economic values for the 2 new health traits in the dairy system and for residual feed intake across all cattle categories in both systems were 1.4 and 8%, respectively. Within the dairy production system, the highest relative economic values were for milk yield (20%), daily gain of calves (20%), productive lifetime (10%), and cow conception rate (8%). In the cow-calf system, the most important traits were weight gain of calves from 120 to 210 d and from birth to 120 d (19 and 14%, respectively), productive lifetime (17%), and cow conception rate (13%). Based on the calculation of economic values for traits in the dual-purpose Pinzgau breed, milk production and growth traits remain highly important in the breeding goal, but their relative importance should be adapted to new production and economic conditions. The economic importance of functional traits (especially of cow productive lifetime and fertility) was sufficiently high to make the inclusion of these traits into the breeding goal necessary. An increased interest of consumers in animal welfare and quality of dairy farm products should probably lead to the incorporation of health traits (clinical mastitis incidence and somatic cells score) into the breeding goal. However, keeping carcass traits in the breeding goal of the Slovak Pinzgau breed does not seem to be relevant to the long-term market situation.

Pars plana vitrectomy in the pediatric population: indications and long-term results.

PURPOSE: To establish the indications and the long-term results of pars plana vitrectomy (PPV) in the pediatric population. METHODS: PPV was performed in 60 eyes of 57 children, 45 boys and 12 girls, aged from 6 to 15 years. Twenty-nine eyes (48%) suffered from complicated rhegmatogenous or traction retinal detachment (RD) with advanced proliferative vitreoretinopathy (PVR), 19 eyes (32%) had RD due to an idiopathic or traumatic giant tear (GT), 7 eyes (11%) had an intraocular foreign body (IOFB), and 5 eyes (9%) had hemorrhage or exudation into the vitreous. In 43 eyes (65%) silicone oil implantation (SOI) was indicated, in 39 eyes (91%) a primary SOI, and in 4 eyes (9%) a secondary SOI. The patients were followed up for 6-72 months, mean 42 months. RESULTS: At the end of follow-up, anatomical success with a flat macula was achieved in 77% of the eyes, and functional success with visual acuity of 0.02 and better in 72%. The results were best in IOFB and traction RD after penetrating injury (success in 100% and 91%); the worst results were in RD after regressed retinopathy of prematurity and RD due to idiopathic GT (success in 50% and 54%). After SOI silicone oil was removed in 27 out of 43 eyes (63%), and the retina remained attached in 23 of these eyes (85%). CONCLUSIONS: Indications and the long-term results of PPV in children were comparable with those in the adult. By far the most frequent indications were injuries and their complications. In complicated RD, a radical approach with primary SOI and later silicone oil removal proved useful. In children, with their long life expectancy, timely removal of silicone oil is vital for maintaining the function of the eye.

[Long-term results of pars plana vitrectomy and silicone oil in large retinal tears in children]. / Dlouhodobé výsledky pars plana vitrektomie a silikonového oleje u obrovských trhlin sítnice detského veku.

Pars plana vitrectomy (PPV) with implantation of silicone oil (ISO) was performed giant tears (GT) in 24 eyes of 22 children aged 6-15 years. In 15 eyes of 13 children idiopathic GT were involved (71%), in 9 eyes (29%) the GT was preceded by an injury-contusion in 5 eyes and a perforating injury in 4 eyes. The patients were followed up for 24-132 months after operation, on average for 55 months. The final anatomical success with an attached macula and functional success with a visual acuity of 0.02 or better were achieved in 18 eyes (75%). The results did not depend on the size of the GT and were better in post-traumatic than in idiopathic GT. The success of the operation declined from 82% after two years and 79% after 3 years to 45% after 5 and more years. The silicone oil was removed in 13 years (46%). Of those in 4 eyes (31%) the detachment relapsed and in two eyes (15%) the relapse was the cause of the final failure. PPV with ISO was a very effective operation in GT. Proliferative vitreoretinopathy was the main cause of surgical failures and a frequent obstacle for removal of silicone oil from the eye. Dispensarization, prophylactic cryopexy and early diagnosis of GT are the main prerequisites of a better prognosis and results in GT in children.

Long-term results of pars plana vitrectomy and silicone oil for giant tears.

PURPOSE: To evaluate the long-term results of pars plana vitrectomy (PPV) and silicone oil implantation (SOI) for giant retinal tears (GT). METHODS: PPV with SOI was performed for GT in 50 eyes of 46 patients. Thirty-one eyes (62%) of 27 patients suffered from idiopathic GT. A direct injury of the eye preceded GT in 19 eyes (38%), a contusion in 14 and perforation of the sclera in five. The patients were followed up for 12 to 96 months, with a mean of 33 months. RESULTS: At the end of follow-up, anatomical success with a flat macula was achieved in 39 eyes (78%). Functional success with visual acuity 0.02 or better was obtained in 37 eyes (74%). The final functional results did not depend on the size of the GT, and were better in post-traumatic GT (success in 84%) than in idiopathic ones (success in 68%). The functional success rate by life table analysis decreased from 81% after one year and 79% after three years to 55% after five or more years. Silicone oil was removed from 22 eyes (44%). After removal, the retina redetached in seven eyes (30%), and the redetachment caused final failure in two (9%). CONCLUSIONS: PPV with SOI proved highly effective in GT. Proliferative vitreoretinopathy was the main cause of surgical failure and a frequent obstacle to silicone oil removal. The risks of redetachment have to be evaluated especially carefully when dealing with the only eye.

[Malignant intraocular lymphoma]. / Nitroocní maligní lymfom.

A thirty-year-old patient irradiated five years previously on account of a cerebral tumour was admitted for pars plana vitrectomy with the diagnosis of bilateral chronic uveitis and secondary glaucoma. The intraocular inflammation was characterized by corneal precipitates, pseudohypopyon, circulating large cell conglomerates in the anterior chamber and a dense whitish infiltration of the vitreous cavity. Because an intraocular malignant lymphoma was suspected, repeatedly a diagnostic pars plana vitrectomy was performed on the right eye and once on the left eye and bilateral actinotherapy was administered. Only the last cytological examination revealed the presence of lymphoma cells. The course of the disease on the two eyes differed. In the right eye despite repeated actinotherapy and repeated pars plana vitrectomy the disease proceeded by infiltration of the retina and the optic disc. In the left eye after par plana vitrectomy the finding on the ocular fundus was permanently without focal changes. An intraocular malignant lymphoma is usually masked by the picture of chronic uveitis. Careful analysis of the case-history, clinical picture and above all the awareness of this life threatening disease, are decisive for establishment of the correct diagnosis.