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F. Liang, C. Terrada, G. Ducos de Lahitte, P. Quartier, P. Lehoang, B. Bodaghi; Foveal Serous Retinal Detachment in Juvenile Idiopathic Arthritis-Associated Uveitis: Visual Outcome and Optical Coherence Tomography Features. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1524.
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© ARVO (1962-2015); The Authors (2016-present)
To characterize the foveal serous retinal detachment (FSRD) in juvenile idiopathic arthritis(JIA)-associated uveitis. To investigate the correlation with visual acuity (VA) and ocular inflammatory activity.
Among 38 children having maculopathy with JIA-associated uveitis and managed between 2005-2007, 8 patients with FSRD were identified. All patients were treated with additional therapy: periocular steroid injection (n=2), systemic anti-tumor necrosis factor antibody (n=6). Outcome measures included VA, ocular inflammatory activity quantified by laser flare photometry and the macular profile analyzed by optical coherence tomography.
All patients (7 female, 1 male) had bilateral uveitis and 5 had bilateral SRD. All patients had risk factors to develop severe anterior uveitis during the course of the disease. The mean age at the onset of uveitis and at the diagnosis of FSRD was 3.7±0.75 years and 7.5±2.3 years, respectively. At the onset of FSRD 5/8 children were refractory to methotrexate and systemic corticosteroids. We observed a high frequency and severity of ocular complications: 85% posterior synechiae, 77% cataract, 54% band keratopathy and 23% glaucoma. FSRD appeared isolated in 24% of eyes (mean VA =0.45logMAR), it was associated with perifoveolar thickening in 74%, with diffuse macular edema in 45% (mean VA=0.67logMAR) and with cystoid macular edema in 7% of cases. Before therapeutic intensification, the mean VA was 0.52logMAR, the mean foveal thickness (FT) was 272µm, the mean perifoveolar thickness (PFT) was 330µm. At 6 months follow-up: VA increased to 0.25logMAR (p=0.003), the reduction of flare was 35% (p=0.002), the mean FT was 237µm (p=0.2), the mean PFT was 317µm (p=0.28), only 1 eye showed persistant SRD. At 12 months follow-up, the mean VA was 0.13logMAR (p=0.0002), the mean FT was 225µm (p=0.13), the mean PFT was 314µm (p=0.09) and foveal SRD persisted in 1 eye.
FSRD is a late-stage complication of sustained and insufficiently treated anterior uveitis in children with JIA-associated uveitis and must be considered for the long-term visual outcome. An agressive immunomodulatory strategy is mandatory in order to achieve strict control of ocular inflammation and improve the visual function.
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