Abstract
Purpose: :
To investigate the prevalence of serous macular detachment in children with juvenile idiopathic arthritis and uveitis.
Methods: :
Cross–sectional study, from May to October 2005. Children suffering from juvenile arthritis and uveitis underwent complete examination including best corrected visual acuity, slit–lamp examination and funduscopy. Uveitis was considered clinically controlled in all cases. Laser flare photometry and OCT were performed by another examiner at the same day. Macular thickness and line scan protocols applied (Carl Zeiss Meditec, Software 3) in all patients. The height of serous macular detachment was measured manually from line scans. The central foveal thickness was obtained from the topographic map. Exclusion criteria were opacities of the optic media and low–quality OCT images
Results: :
Fifteen children (28 eyes) were included. All patients were treated with methotrexate and systemic and/or topical steroids. Mean age was 12 years. Mean duration of uveitis was 6.5 years. Mean visual acuity was 20/30. Mean value of laser flare meter was 45 photons/ms. Mean central foveal thickness was 238 microns. Serous neurosensory macular detachment was diagnosed in three eyes (10.7%) by biomicroscopic examination. OCT revealed serous neurosensory macular detachment without intra retinal cysts in four eyes (14.3%). In these eyes, mean central foveal thickness was 277 microns with mean height of serous neurosensory macular detachment of 40microns. Mean value of flare was higher in eyes with serous neurosensory macular detachment than those without serous neurosensory macular detachment (mean value = 154 ph/ms versus 45 ph/ms). In one case, serous macular detachment resolved after high dose corticosteroids, which were administered after cataract surgery of the other eye.
Conclusions: :
The prevalence of serous macular detachment in children with juvenile arthritis and uveitis may be higher with OCT detection than clinical examination. The presence of serous macula detachment may correspond to the break down of the blood retinal barrier induced by chronic subclinical inflammation and may justify an intensive treatment.
Keywords: inflammation • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)