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Brian Savoie, Rudrani Banik; Pediatric uveitis associated optic disc edema. Invest. Ophthalmol. Vis. Sci. 2014;55(13):103.
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Optic disc edema (ODE) secondary to uveitis has been reported in both pediatric and adult populations. The incidence of ODE in uveitis patients ranges from 1.8-22%, yet outcomes remain poorly defined. We describe five cases of pediatric uveitis associated with ODE.
Retrospective case series of pediatric patients presenting to the uveitis clinic of a tertiary referral center from 2007-2012. Patient demographics, clinical characteristics, treatment, and outcomes were recorded.
ODE was observed in 5/58 (8.6%) of patients, 2/5 cases were bilateral totaling 7 eyes. 3/5 of cases were male and 2/5 female. Mean age was 11 years (range: 8-15). 4/5 of cases were associated with anterior uveitis, and 1 with panuveitis. In 2/5 underlying pathologies were identified (JRA, HSV), while a third was HLA-B27+. 5/5 required treatment with both topical and systemic steroids, 2 received systemic methotrexate, and 1 anti-TNF therapy. Mean follow-up was 23 months (range: 3-47). Mean time to resolution of uveitis and ODE in days were 129 (range: 37-336) and 165 (range: 79-336), respectively. Complications occurred in 2/5, including band keratopathy, synechiae, and cataract.
As has been previously reported, both idiopathic and secondary forms of uveitis were represented amongst patients with secondary ODE. Although our sample size was limited, we observed both a longer time to resolution of uveitis and ODE then previous studies. While prior studies have concluded that topical immunosuppression may be adequate, we describe 5 cases in which systemic treatment was required to control inflammation and reduce optic disc swelling. Consistent with prior findings, ODE resolution lagged behind that of uveitis requiring no addition treatment. ODE may be associated with severe uveitis requiring systemic immunosuppression. Providers should maintain a low threshold for systemic therapy or referral in patients who fail topical treatment.
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