The role of human immunodeficiency virus in the pathogenesis of vernal keratoconjunctivitis-like disease in adults: A demographic and epidemiological study.

Purpose: The purpose was to identify and describe patients with new-onset vernal keratoconjunctivitis-like (VKC-like) disease after puberty. Methods: The study consisted of two parts: a prospective observational descriptive study of patients with new-onset VKC-like disease, and a case-control study to determine the relationship of a CD4 count with VKC-like disease in adults, in the setting of human immunodeficiency virus (HIV). Patients were recruited between January 2016 and November 2017 from a Provincial Eye hospital, one of two large referral hospitals in KwaZulu-Natal, South Africa. Patients presenting to the eye clinic were screened and diagnosed at the Primary Eye Care Unit. Inclusion criteria: age 15 years and older with signs and symptoms of new-onset VKC-like disease. Exclusion criteria: a history of childhood atopic diseases, atopic keratoconjunctivitis and patients who declined HIV testing. Data collected included HIV status, CD4 count, antinuclear antibodies and total serum immunoglobulin E. Results: Thirty-three patients were included; females n = 16 and males n = 17. The mean age at presentation was 32.45 ± 9.93 years, 95% CI = 28.94-35.97. Twenty-six patients (78.8%) were HIV positive, 95% CI (62-89). The proportion of HIV positive patients was statistically different from the HIV negative group, Chi-squared = 21.866, P value <0.0001. In the group of HIV positive patients, 72% were classified as immunodeficient according to their CD4 counts. An association was proven between severely immunodeficient patients and the risk of VKC-like disease (Chi-squared = 4.992, P value = 0.0255). Conclusion: In this cohort, a statistically significant association was found between VKC-like disease in adults and an HIV positive status. This association calls for more research on the subject.

A case report of torpedo maculopathy in an African boy.

We describe a case report of torpedo maculopathy in a young African boy. Ophthalmic examination revealed normal visual acuity and a characteristic unilateral retinal lesion with the typical appearance on ocular coherence tomographic imaging, fluorescein angiography, and visual fields testing.

Retinoblastoma and Hirschsprung disease with a 13q14 to 22 deletion.

Hirschsprung disease, bilateral retinoblastoma, and craniofacial dysmorphism with an interstitial deletion of chromosome 13 is a rare gene deletion syndrome that has twice before been described in white children. The authors present the third report of such a case in a South African child of Indian-Asian descent.

Cataract surgery in pediatric uveitis.

Uveitis in children is associated with several sight-threatening ocular complications, including the formation of cataracts. The surgical management of uveitic cataracts in children is both challenging and controversial and, unlike in adult uveitic cataracts, surgery has historically been associated with poor visual outcomes. Juvenile idiopathic arthritis-associated uveitis in particular poses unique therapeutic challenges and the issue of correction of aphakia in these patients remains a contentious one. The growing use of immunotherapies and, where needed, targeted biologic agents in childhood uveitis increases our potential to implant lenses and predict outcomes. The authors review the available evidence base for the treatment of these children.

Uveitis in children with human immunodeficiency virus-associated arthritis.

PURPOSE: To describe the ocular inflammatory manifestations and clinical characteristics of children with Human Immunodeficiency Virus (HIV)-associated arthritis. METHODS: A retrospective review of the charts of children with chronic uveitis and HIV-associated arthritis seen between June 2004 and September 2006 at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. The following data were analyzed: age at presentation, gender, race/ethnicity, rheumatologic problems, uveitic diagnosis, laboratory findings, and ocular complications. RESULTS: Seven black African males with a mean age of 9 years (range, 4 to 13 years) were identified. There were no other significant laboratory findings apart from HIV; all patients were antinuclear antibody negative. Arthritis was polyarticular in 6 patients and pauciarticular in 1. Four patients had intermediate uveitis and 3 patients had nongranulomatous anterior uveitis. Visual acuity ranged from 20/20 to hand movements. Ocular complications included cataract, cystoid macular edema, hypotony, pupillary membranes, band keratopathy, posterior synechiae and optic disk edema. CONCLUSIONS: HIV-associated arthritis and uveitis in children is a clinical syndrome that may be associated with severe sight-threatening intraocular inflammation. Routine eye screening in HIV-positive children, particularly those with arthritis, is warranted to facilitate prompt treatment.