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Barbara Giampietro, Fernanda Maria Silveira Souto, Julia Tieme Takiuti, Lúcia Maria Arruda Campos, Carlos Eduardo Hirata, Joyce H Yamamoto; Retinal vasculitis (RV) in pediatric population: case series. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4596.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the clinical characteristics of RV in children in a referral center in Sao Paulo, SP, Brazil
Retrospective, cross-sectional study, including patients from 0-16 years old with RV and minimum one year follow-up, attended at Uveitis Service, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil, between April, 2017 and September,2019. All patients were assessed with a detailed anamnesis, with a systemic workup for potentially associated infectious and/or systemic diseases. All included patients had a baseline fluorescein angiography (FA). Data retrieved and analyzed were: ocular and systemic symptoms, age at diagnosis, gender, laterality, duration of follow-up, best corrected visual acuity (BCVA, Snellen chart), tonometry, slit-lamp examination and indirect ophthalmoscopy findings, local and/or systemic medical therapies. Ocular complications were recorded if they occurred at any time point. An effective treatment was defined as an increase of 2 lines in BCVA, a 2-fold decrease in anterior chamber (ACC) and/or anterior vitreous (AV) cells, improvement in FA score based on vascular leakage pattern and/or cystoid macular edema (Tugal-Tutkun et al, 2010). This study was approved by Institutional Ethics Committee (CapPesq 2.289.047).
Among the 7 children (5F/2M) included in the study, it was bilateral in 6 children (86%), the mean age at diagnosis was 9.9±1.3 years, with a mean follow-up period of 34±16.3 months. Diagnosis was Behçet syndrome (1 case), post yellow fever vaccination (1 case), idiopathic non infectious (4 cases) and retinitis pigmentosa (1 case, previous diagnosis of intermediate uveitis).Nine eyes (64%) had improvement in BCVA; all eyes had ACC improvement, whereas AV cells improved in six eyes (42.8%). Among the four children (8 eyes) with a follow-up FA, it was stable or improved in all these eyes. Nevertheless, all children, except one, had at least two or more steps of immunosuppression increase and five children (71.4%) were still under low-dose oral prednisone.
This small case series pointed out to the refractory nature of retinal vasculitis in pediatric patients. Specific studies in this age group provide a better understanding of the particularities regarding etiology, treatment and prognosis of RV in children.
This is a 2020 ARVO Annual Meeting abstract.
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