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A.-M. Lobo, G. Papaliodis, L. Sobrin, C. Westerfeld, S. Mukai; Pediatric Pars Planitis: Presentation, Treatment, and Outcomes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1533.
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Pars planitis is an idiopathic intermediate uveitis characterized by vitritis and pars plana snowbanking. Visual loss is due to vitreous inflammation, cystoid macular edema, cataract, and vitreous hemorrhage from retinal neovascularization. Pars planitis comprises up to 20% of all cases of pediatric uveitis; studies have suggested that pediatric pars planitis leads to poorer vision compared to adult cases. Factors involved in these outcomes may be delayed diagnosis and inadequate treatment. We present cases of pediatric pars planitis to illustrate the variability of presentation, treatment and outcomes.
We performed a retrospective chart review of all cases of pars planitis in patients under age 18 years seen in the Retina Service and the Uveitis Service at Massachusetts Eye and Ear Infirmary from 2004 to 2008. Five patients were identified in whom systemic work-up was negative.
There were three male and two female patients. The average age at time of diagnosis was 9.8 years. Reasons for initial presentation included amblyopia, incidental finding on evaluation of a corneal abrasion, failed school vision screening with vitreous hemorrhage, decreased vision, and floaters. Three patients had unilateral involvement. All patients received at least one periocular steroid injection with an average of 2.2 injections per affected eye. Three patients were maintained on some form of immunomodulatory therapy with an average of two different medications utilized per patient. Three patients underwent pars plana vitrectomy. Three patients had peripheral retinal neovascularization treated with cryotherapy. Visual acuity improved in all patients after treatment, with an average of 4 lines of improvement.
Pars planitis in pediatric patients may cause significant visual impairment, and its presentation may vary considerably. Periocular steroid injection, immunomodulatory therapy, cryotherapy, and pars plana vitrectomy may be required to treat pars planitis and its complications such as peripheral retinal neovascularization. Prompt, adequate therapy is required to prevent permanent visual compromise and amblyopia in younger children.
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