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Published on: January 7, 2019
Long-Term Outcomes of Pediatric Pars Planitis: Retrospective Cohort from a Single Tertiary Center in Turkey
Aslıhan Yılmaz Çebi1, Oğuzhan Kılıçarslan2, Didar Uçar3
1Department of Ophthalmology, Çerkezköy State Hospital, Tekirdağ, Turkey.
Insights
Pediatric pars planitis (PP) can cause vision-threatening complications, but long-term outcomes improve with treatment. Immunomodulatory and biologic agents help control inflammation and reduce corticosteroid use in pediatric patients with pars planitis.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Uveitis
Background:
- Pediatric pars planitis (PP) is a form of intermediate uveitis characterized by vitreal inflammation and snowbank/snowball formation.
- While often considered to have a mild course, PP can lead to sight-threatening complications affecting vision.
- Understanding the long-term outcomes and effective management strategies for pediatric PP is crucial for preserving visual function.
Purpose of the Study:
- To retrospectively analyze the long-term outcomes of pediatric pars planitis (PP).
- To evaluate the efficacy of various treatment modalities in managing pediatric PP.
- To identify common complications and their impact on visual acuity in pediatric patients.
Main Methods:
- Retrospective analysis of medical records from 44 patients (85 eyes) diagnosed with pediatric pars planitis.
- Collection of demographic data, clinical characteristics, presenting symptoms, and treatment regimens.
- Assessment of best-corrected visual acuity (BCVA) and ocular inflammation parameters at presentation and during follow-up.
Main Results:
- The study included 85 eyes of 44 patients, with a mean age of 10.4 years and a mean follow-up of 42.8 months.
- Common presenting symptoms included blurry vision, redness, and pain. Sight-threatening complications such as optic disc edema, cataracts, macular edema, and glaucoma were frequent.
- Mean BCVA significantly improved from presentation (0.17/0.27 logMAR) to final examination (0.08/0.06 logMAR). Inflammatory markers also decreased significantly (p < 0.001).
- Systemic treatments, including corticosteroids, azathioprine, methotrexate, cyclosporine, adalimumab, and infliximab, were utilized. Thirty-one patients remained on systemic treatment at the final visit, with only four on corticosteroids.
Conclusions:
- Pediatric pars planitis, despite a potentially mild initial course, can lead to severe vision-threatening complications.
- Immunomodulatory and biologic agents play a vital role in controlling inflammation and enabling the tapering of corticosteroid therapy.
- Further research is warranted to optimize treatment strategies and improve long-term visual outcomes for pediatric patients with PP.
Purpose:
To retrospectively analyze long-term outcomes of pediatric pars planitis (PP).
Methods:
PP was defined as vitreal inflammation with snowbank or snowball formation in the absence of a related disease. Eighty-five eyes of 44 patients were included in this study. Demographic and clinical characteristics were obtained from medical records.
Results:
Approximately 70% of the patients were males; the mean patient age was 10.4 ± 3.6 years at presentation, and the mean follow-up time was 42.8 ± 27.9 months. At presentation, the mean best corrected visual acuity (BCVA, logMAR) was 0.17 ± 0.27 in the right eyes and 0.27 ± 0.33 in the left eyes. Common symptoms included blurry vision (29 eyes, 65%), redness (17, 38%), pain (8, 18%), and floaters (5, 11%). Sight-threatening complications included optic disc edema/hyperemia (26, 30%), cataracts (16, 18%), macular edema (16, 18%), and glaucoma (15, 17%). All 38 patients who initially required systemic treatment received corticosteroids. During the follow-up, 24 patients were treated with azathioprine, 20 with methotrexate, 11 with cyclosporine, 20 with adalimumab, and 8 with infliximab. At the final examination, the mean BCVA of the right and left eyes improved significantly (0.08 ± 0.23 and 0.06 ± 0.17, p = 0.006 and p < 0.001, respectively). The severities of vitritis, anterior chamber inflammation, snowbank/snowball formation, and endotheliitis decreased (all p < 0.001). Thirty-one patients remained on systemic treatment, with only four patients still receiving corticosteroids. No life-threatening adverse effects were reported.
Conclusion:
Despite pediatric PP's mild course, severe vision-threatening complications can occur. Immunomodulatory or biologic agents are important for controlling inflammation and tapering corticosteroids. Further research could enhance understanding of optimal treatments.
