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Pediatric uveitis: A comprehensive review
Survey of Ophthalmology ( IF 5.1 ) Pub Date : 2021-06-25 , DOI: 10.1016/j.survophthal.2021.06.006
Arash Maleki 1 , Stephen D Anesi 1 , Sydney Look-Why 1 , Ambika Manhapra 1 , C Stephen Foster 2
Affiliation  

Pediatric uveitis accounts for 5–10% of all uveitis. Uveitis in children differs from adult uveitis in that it is commonly asymptomatic and can become chronic and cause damage to ocular structures. The diagnosis might be delayed for multiple reasons, including the preverbal age and difficulties in examining young children. Pediatric uveitis may be infectious or noninfectious in etiology. The etiology of noninfectious uveitis is presumed to be autoimmune or autoinflammatory. The most common causes of uveitis in this age group are idiopathic and juvenile idiopathic arthritis-associated uveitis. The stepladder approach for the treatment of pediatric uveitis is based on expert opinion and algorithms proposed by multidisciplinary panels. Uveitis morbidities in pediatric patients include cataract, glaucoma, and amblyopia. Pediatric patients with uveitis should be frequently examined until remission is achieved. Once in remission, the interval between follow-up visits can be extended; however, it is recommended that even after remission the child should be seen every 8–12 weeks depending on the history of uveitis and the medications used. Close follow up is also necessary as uveitis can flare up during immunomodulatory therapy. It is crucial to measure the impact of uveitis, its treatment, and its complications on the child and the child's family. Visual acuity can be considered as an acceptable criterion for assessing visual function. Additionally, the number of cells in the anterior chamber can be a measure of disease activity.

We review different aspects of pediatric uveitis. We discuss the mechanisms of noninfectious uveitis, including autoimmune and autoinflammatory etiologies, and the risks of developing uveitis in children with systemic rheumatologic diseases. We address the risk factors for developing morbidities, the Standardization of Uveitis Nomenclature (SUN) criteria for timing and anatomical classifications, and describe a stepladder approach in the treatment of pediatric uveitis based on expert opinion and algorithms proposed by multi-disciplinary panels. In this review article, We describe the most common entities for each type of anatomical classification and complications of uveitis for the pediatric population. Additionally, we address monitoring of children with uveitis and evaluation of Quality of Life.



中文翻译:

小儿葡萄膜炎:综合综述

小儿葡萄膜炎占所有葡萄膜炎的 5-10%。儿童葡萄膜炎与成人葡萄膜炎的不同之处在于它通常是无症状的,并且可能会变成慢性并导致眼部结构受损。诊断可能因多种原因而延迟,包括语言前年龄和检查幼儿的困难。小儿葡萄膜炎的病因可能是传染性的或非传染性的。非感染性葡萄膜炎的病因被认为是自身免疫性或自身炎症性。这个年龄组葡萄膜炎最常见的原因是特发性和幼年特发性关节炎相关的葡萄膜炎。治疗小儿葡萄膜炎的阶梯式方法基于专家意见和多学科小组提出的算法。儿科患者的葡萄膜炎发病率包括白内障、青光眼和弱视。应经常检查患有葡萄膜炎的儿科患者,直至达到缓解。一旦缓解,可延长复诊间隔;然而,根据葡萄膜炎的病史和使用的药物,建议即使在病情缓解后,也应每 8-12 周对孩子进行一次检查。密切随访也是必要的,因为在免疫调节治疗期间葡萄膜炎可能会突然发作。衡量葡萄膜炎的影响、治疗及其并发症对儿童和儿童家庭的影响至关重要。视力可以被认为是评估视觉功能的可接受标准。此外,前房中的细胞数量可以衡量疾病活动度。然而,根据葡萄膜炎的病史和使用的药物,建议即使在病情缓解后,也应每 8-12 周对孩子进行一次检查。密切随访也是必要的,因为在免疫调节治疗期间葡萄膜炎可能会突然发作。衡量葡萄膜炎的影响、治疗及其并发症对儿童和儿童家庭的影响至关重要。视力可以被认为是评估视觉功能的可接受标准。此外,前房中的细胞数量可以衡量疾病活动度。然而,根据葡萄膜炎的病史和使用的药物,建议即使在病情缓解后,也应每 8-12 周对孩子进行一次检查。密切随访也是必要的,因为在免疫调节治疗期间葡萄膜炎可能会突然发作。衡量葡萄膜炎的影响、治疗及其并发症对儿童和儿童家庭的影响至关重要。视力可以被认为是评估视觉功能的可接受标准。此外,前房中的细胞数量可以衡量疾病活动度。它的治疗,以及它对孩子和孩子家庭的并发症。视力可以被认为是评估视觉功能的可接受标准。此外,前房中的细胞数量可以衡量疾病活动度。它的治疗,以及它对孩子和孩子家庭的并发症。视力可以被认为是评估视觉功能的可接受标准。此外,前房中的细胞数量可以衡量疾病活动度。

我们回顾了小儿葡萄膜炎的不同方面。我们讨论了非感染性葡萄膜炎的机制,包括自身免疫性和自身炎症性病因,以及患有系统性风湿病的儿童发生葡萄膜炎的风险。我们解决了发展为发病率的风险因素、葡萄膜炎命名标准化 (SUN) 时间和解剖分类标准,并根据专家意见和多学科小组提出的算法描述了治疗小儿葡萄膜炎的阶梯式方法。在这篇综述文章中,我们描述了儿科人群葡萄膜炎的每种解剖分类和并发症的最常见实体。此外,我们还解决了对患有葡萄膜炎的儿童的监测和生活质量的评估。

更新日期:2021-06-25
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