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Jason Kian Seng Lee, Su Ling Ho, Stephen Teoh; Childhood Uveitis in a Developed Asian Country. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2730.
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Children constitute about 5 - 10% of patients with uveitis. Data regarding the epidemiology and disease characteristics of childhood uveitis have been relatively limited, especially in the Asian population. This study aims to review the spectrum of childhood onset uveitis encountered in our hospital uveitis clinic.
Retrospective chart review of patients aged 21 years old and below who attended the uveitis clinic at Tan Tock Seng Hospital between 1 Jan 2000 and 31 March 2010.
Thirty-four patients (45 eyes) were encountered of whom 22 (64.7%) were males. The ethnic distribution was predominantly Chinese (91.1%). The median age at diagnoses was 16.7 ± 3.5 years. The most common presentations were eye redness (60.0%) and blurring of vision (31.1%). The leading diagnoses were idiopathic anterior uveitis (26.7%) and idiopathic intermediate uveitis (15.6%). Anterior uveitis (44.4%) was the most common form of uveitis encountered, followed by intermediate uveitis (20.0%), posterior uveitis (17.8%) and panuveitis (17.8%). Four eyes (8.9%) had an infectious cause of uveitis, including tuberculosis, herpes simplex and toxoplasma.There was only 1 patient (2 eyes) with juvenile rheumatoid arthritis related uveitis. The most common complications at presentation were posterior synechiae (24.4%), optic disc swelling (22.2%) and cystoid macular oedema (13.3%). With subsequent follow-ups, a higher incidence of cataracts was noted, with 20.0% developing cataracts at 1 year and 42.9% at 3 years. Nine eyes (20.0%) had a best-corrected visual acuity worse than 6/18 on presentation of which 5 eyes (14.3%) had a residual visual acuity of worse than 6/18 at 1 year. Three of these 5 eyes had presented more than 1 month after the onset of symptoms. Forty-three eyes (95.6%) were treated with steroids of which 42 patients (97.7%) received topical steroids. Fourteen eyes (31.1%) were treated with a combination of steroids with systemic immunosuppressive agents including azathioprine, methotrexate, tacrolimus, mycophenolate mofetil and cyclosporin A. One patient was treated with the biologic agent adalimumab.
Juvenile rheumatoid arthritis related uveitis is very uncommon in our paediatric population. Our study on childhood uveitis among our local patient population resonates the same message with studies from other parts of the world that it is associated with a wide spectrum of pathology complicated by significant visual co-morbidity. It is important that childhood uveitis is detected early and referred to a specialist for prompt treatment.
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