Download PDF
Klin Monbl Augenheilkd 2020; 237(10): 1177-1186
DOI: 10.1055/a-1252-5281
Übersicht

Childhood Uveitis

Article in several languages: English | deutsch
Stephan Thurau
Augenklinik, Klinikum der LMU München, München, Deutschland
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Childhood uveitis is an ophthalmological challenge, since on the one hand it often remains asymptomatic and difficult to detect, and on the other hand it often has a chronic course and is associated with a high risk of complications threatening the vision. The most important risk factors for childhood uveitis are underlying rheumatic diseases; recommendations for ophthalmological monitoring have been developed together with paediatric rheumatologists. Intermediate and posterior uveitis are rare in children. The therapy must effectively control inflammation and at the same time cause only minimal side effects. Since steroids in particular cause side effects frequently, an immunosuppressive therapy must be initiated early in an interdisciplinary cooperation with paediatric rheumatologists and parents with the goal of minimising steroids.

Key words

uveitis - paediatric ophthalmology - therapy


Publication History

Received: 18 August 2020

Accepted: 17 September 2020

Article published online:
15 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References/Literatur

  • 1 Paroli MP, Spinucci G, Liverani M. et al. Uveitis in childhood: an Italian clinical and epidemiological study. Ocul Immunol Inflamm 2009; 17: 238-242
    CrossrefPubMedGoogle Scholar
  • 2 Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005; 140: 509-516
    CrossrefPubMedGoogle Scholar
  • 3 Heiligenhaus A, Minden K, Tappeiner C. et al. Leitlinie 045-012, S2k, Diagnostik und antientzündliche Therapie der Uveitis bei juveniler idiopathischer Arthritis. 2018 Accessed September 6, 2020 at: https://www.awmf.org/leitlinien/detail/ll/045-012.html
    PubMedGoogle Scholar
  • 4 Heiligenhaus A, Minden K, Tappeiner C. et al. Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Semin Arthritis Rheum 2019; 49: 43-55
    CrossrefPubMedGoogle Scholar
  • 5 LaMattina KC, Koreishi AF. What is new in paediatric uveitis?. Curr Opin Ophthalmol 2018; 29: 412-418
    CrossrefPubMedGoogle Scholar
  • 6 Petty RE, Southwood TR, Manners P. et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31: 390-392
    PubMedGoogle Scholar
  • 7 Khochtali S, Abroug N, Megzari K. et al. Swept-source optical coherence tomography angiography findings in uveitic cystoid macular edema. Ocul Immunol Inflamm 2019; 27: 1211-1223
    CrossrefPubMedGoogle Scholar
  • 8 Sancho L, Kramer M, Koriat A. et al. Complications in intermediate uveitis: prevalence, time of onset, and effects on vision in short-term and long-term follow-up. Ocul Immunol Inflamm 2019; 27: 447-455
    CrossrefPubMedGoogle Scholar
  • 9 Engelhard SB, Bajwa A, Reddy AK. Causes of uveitis in children without juvenile idiopathic arthritis. Clin Ophthalmol 2015; 9: 1121-1128
    CrossrefPubMedGoogle Scholar
  • 10 Poddighe D, Mukusheva Z, Dauyey K. et al. Adalimumab in the treatment of pediatric Behcetʼs disease: case-based review. Rheumatol Int 2019; 39: 1107-1112
    CrossrefPubMedGoogle Scholar
  • 11 Diwo E, Gueudry J, Saadoun D. et al. Long-term efficacy of interferon in severe uveitis associated with Behçet disease. Ocul Immunol Inflamm 2017; 25: 76-84
    CrossrefPubMedGoogle Scholar
  • 12 Guillaume-Czitrom S, Berger C, Pajot C. et al. Efficacy and safety of interferon-alpha in the treatment of corticodependent uveitis of paediatric Behcetʼs disease. Rheumatology (Oxford) 2007; 46: 1570-1573
    CrossrefPubMedGoogle Scholar
  • 13 Morelle G, Gueudry J, Uettwiller F. et al. Chronic and recurrent non-infectious paediatric-onset uveitis: a French cohort. RMD Open 2019; 5: e000933
    CrossrefPubMedGoogle Scholar
  • 14 Smith JA, Mackensen F, Sen HN. et al. Epidemiology and course of disease in childhood uveitis. Ophthalmology 2009; 116: 1544-1551 1551.e1
    CrossrefPubMedGoogle Scholar
  • 15 Gordon KB, Rugo HS, Duncan JL. et al. Ocular manifestations of leukemia. Leukemic infiltration versus infectious process. Ophthalmology 2001; 108: 2293-2300
    CrossrefPubMedGoogle Scholar
  • 16 Ramanan AV, Dick AD, Benton D. et al. A randomised controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis (SYCAMORE Trial). Trials 2014; 15: 14
    CrossrefPubMedGoogle Scholar
  • 17 Calvo-Río V, Santos-Gómez M, Calvo I. et al. Anti-interleukin-6 receptor tocilizumab for severe juvenile idiopathic arthritis-associated uveitis refractory to anti-tumor necrosis factor therapy: A multicenter study of twenty-five patients. Arthritis Rheumatol 2017; 69: 668-675
    CrossrefPubMedGoogle Scholar
  • 18 Tappeiner C, Mesquida M, Adan A. et al. Evidence for tocilizumab as a treatment option in refractory uveitis associated with juvenile idiopathic arthritis. J Rheumatol 2016; 43: 2183-2188
    CrossrefPubMedGoogle Scholar
  • 19 Horneff G, Klein A, Klotsche J. et al. Comparison of treatment response, remission rate and drug adherence in polyarticular juvenile idiopathic arthritis patients treated with etanercept, adalimumab or tocilizumab. Arthritis Res Ther 2016; 18: 272
    CrossrefPubMedGoogle Scholar
  • 20 Adan A, Mesquida M, Llorenc V. et al. Tocilizumab treatment for refractory uveitis-related cystoid macular edema. Graefes Arch Clin Exp Ophthalmol 2013; 251: 2627-2632
    CrossrefPubMedGoogle Scholar
  • 21 Vegas-Revenga N, Calvo-Rio V, Mesquida M. et al. Anti-IL6-receptor tocilizumab in refractory and noninfectious uveitic cystoid macular edema: Multicenter study of 25 patients. Am J Ophthalmol 2019; 200: 85-94
    CrossrefPubMedGoogle Scholar
  • 22 Heiligenhaus A, Miserocchi E, Heinz C. et al. Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab). Rheumatology 2011; 50: 1390-1394
    CrossrefPubMedGoogle Scholar
  • 23 Tappeiner C, Klotsche J, Schenck S. et al. Temporal change in prevalence and complications of uveitis associated with juvenile idiopathic arthritis: data from a cross-sectional analysis of a prospective nationwide study. Clin Exp Rheumatol 2015; 33: 936-944
    PubMedGoogle Scholar
  • 24 Lowder C, Belfort R, Lightman S. et al. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol 2011; 129: 545-553
    CrossrefPubMedGoogle Scholar
  • 25 Winterhalter S, Niehues T. TNFalpha-blocking agents or conventional immunosuppressive drugs in the therapy of children with uveitis? – An evidence based approach. Klin Padiatr 2008; 220: 342-347
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Jabs DA. Immunosuppression for the uveitides. Ophthalmology 2018; 125: 193-202
    CrossrefPubMedGoogle Scholar
  • 27 Li SY, Birnbaum AD, Goldstein DA. Optic neuritis associated with adalimumab in the treatment of uveitis. Ocul Immunol Inflamm 2010; 18: 475-481
    CrossrefPubMedGoogle Scholar
  • 28 Shahab MA, Mir TA, Zafar S. Optimising drug therapy for non-infectious uveitis. Int Ophthalmol 2019; 39: 1633-1650
    CrossrefPubMedGoogle Scholar
  • 29 Bratton ML, He YG, Weakley DR. Dexamethasone intravitreal implant (Ozurdex) for the treatment of pediatric uveitis. J AAPOS 2014; 18: 110-113
    CrossrefPubMedGoogle Scholar
  • 30 Totan Y, Güler E, Guragaç FB. et al. Cystoid macular edema associated with juvenile idiopathic arthritis resolved by a dexamethasone intravitreal implant. J Pediatr Ophthalmol Strabismus 2014; 51: e25-e28
    CrossrefPubMedGoogle Scholar
  • 31 Garweg JG. Macular edema in childhood uveitis. Klin Monbl Augenheilkd 2018; 235: 373-376
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Grajewski RS, Zurek-Imhoff B, Roesel M. et al. Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis. Acta Ophthalmol 2012; 90: 657-662
    CrossrefPubMedGoogle Scholar
  • 33 Angeles-Han ST, McCracken C, Yeh S. et al. Characteristics of a cohort of children with juvenile idiopathic arthritis and JIA-associated uveitis. Pediatr Rheumatol Online J 2015; 13: 19
    CrossrefPubMedGoogle Scholar
  • 34 Oray M, Khachatryan N, Ebrahimiadib N. et al. Ocular morbidities of juvenile idiopathic arthritis-associated uveitis in adulthood: results from a tertiary center study. Graefes Arch Clin Exp Ophthalmol 2016; 254: 1841-1849
    CrossrefPubMedGoogle Scholar
  • 35 Al-Haddad C, BouGhannam A, Abdul Fattah M. et al. Patterns of uveitis in children according to age: comparison of visual outcomes and complications in a tertiary center. BMC Ophthalmol 2019; 19: 137
    CrossrefPubMedGoogle Scholar
  • 36 Rathi VM, Vyas SP, Vaddavalli PK. et al. Phototherapeutic keratectomy in pediatric patients in India. Cornea 2010; 29: 1109-1112
    CrossrefPubMedGoogle Scholar
  • 37 Blum-Hareuveni T, Seguin-Greenstein S, Kramer M. et al. Risk factors for the development of cataract in children with uveitis. Am J Ophthalmol 2017; 177: 139-143
    CrossrefPubMedGoogle Scholar
  • 38 Moradi A, Stroh IG, Reddy AK. et al. Risk of hypotony in juvenile idiopathic arthritis-associated uveitis. Am J Ophthalmol 2016; 169: 113-124
    CrossrefPubMedGoogle Scholar
  • 39 Thorne JE, Woreta FA, Dunn JP. et al. Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology 2010; 117: 1436-1441
    CrossrefPubMedGoogle Scholar
  • 40 Yangzes S, Seth NG, Singh R. et al. Long-term outcomes of cataract surgery in children with uveitis. Indian J Ophthalmol 2019; 67: 490-495
    CrossrefPubMedGoogle Scholar
  • 41 Kulik U, Wiklund A, Kugelberg M. et al. Long-term results after primary intraocular lens implantation in children with juvenile idiopathic arthritis-associated uveitis. Eur J Ophthalmol 2019; 29: 494-498
    CrossrefPubMedGoogle Scholar
  • 42 Jinagal J, Gupta G, Agarwal A. et al. Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis. Indian J Ophthalmol 2019; 67: 69-74
    CrossrefPubMedGoogle Scholar
  • 43 Kothari S, Foster CS, Pistilli M. et al. The risk of intraocular pressure elevation in pediatric noninfectious uveitis. Ophthalmology 2015; 122: 1987-2001
    CrossrefPubMedGoogle Scholar
  • 44 Gautam Seth N, Yangzes S, Thattaruthody F. et al. Glaucoma secondary to uveitis in children in a tertiary care referral center. Ocul Immunol Inflamm 2019; 27: 456-464
    CrossrefPubMedGoogle Scholar
  • 45 Hayasaka Y, Hayasaka S, Zhang XY. et al. Effects of topical antiglaucoma eye drops on prostaglandin E(2)-induced aqueous flare elevation in pigmented rabbits. Invest Ophthalmol Vis Sci 2002; 43: 1142-1145
    PubMedGoogle Scholar
  • 46 Fechtner RD, Khouri AS, Zimmerman TJ. et al. Anterior uveitis associated with latanoprost. Am J Ophthalmol 1998; 126: 37-41 doi:10.1016/s0002-9394(98)00071-3
    CrossrefPubMedGoogle Scholar
  • 47 Halpern DL, Pasquale LR. Cystoid macular edema in aphakia and pseudophakia after use of prostaglandin analogs. Semin Ophthalmol 2002; 17: 181-186
    CrossrefPubMedGoogle Scholar
  • 48 Wiese C, Heiligenhaus AM, Heinz CMF. Changes in inflammatory activity after glaucoma filtration surgery in children with chronic anterior uveitis. Ocul Immunol Inflamm 2016; 24: 397-401 doi:10.3109/09273948.2015.1088041
    CrossrefPubMedGoogle Scholar
  • 49 Böhm MR, Tappeiner C, Breitbach MA. et al. Ocular hypotony in patients with juvenile idiopathic arthritis-associated uveitis. Am J Ophthalmol 2017; 173: 45-55
    CrossrefPubMedGoogle Scholar
  • 50 Sen HN, Drye LT, Goldstein DA. et al. Hypotony in patients with uveitis: The Multicenter Uveitis Steroid Treatment (MUST) trial. Ocul Immunol Inflamm 2012; 20: 104-112
    CrossrefPubMedGoogle Scholar
  • 51 Loh AR, Acharya NR. Incidence rates and risk factors for ocular complications and vision loss in HLA-B27-associated uveitis. Am J Ophthalmol 2010; 150: 534-542.e2
    CrossrefPubMedGoogle Scholar
  • 52 Tran VT, Mermoud A, Herbort CP. Appraisal and management of ocular hypotony and glaucoma associated with uveitis. Int Ophthalmol Clin 2000; 40: 175-203
    CrossrefPubMedGoogle Scholar
  • 53 Eiger-Moscovich M, Tomkins-Netzer O, Amer R. et al. Visual and clinical outcome of macular edema complicating pediatric noninfectious uveitis. Am J Ophthalmol 2019; 202: 72-78
    CrossrefPubMedGoogle Scholar
  • 54 Miraldi Utz V, Bulas S, Lopper S. et al. Effectiveness of long-term infliximab use and impact of treatment adherence on disease control in refractory, non-infectious pediatric uveitis. Pediatr Rheumatol Online J 2019; 17: 79
    CrossrefPubMedGoogle Scholar