Smith Justine R
Casey Eye Institute, Oregon Health Sciences University, Portland, Oregon 97201-4197, USA.
Paediatr Drugs. 2002;4(3):183-9. doi: 10.2165/00128072-200204030-00005.
Uveitis refers to inflammation involving the uvea or middle coat of the eye. This condition occurs uncommonly, particularly in persons aged <or=16 years. However, pediatric uveitis deserves special consideration for reasons that include the relatively poor prognosis, unique systemic associations, and various age-related treatment considerations. Accurate diagnosis requires history from both patient and parents, a complete ophthalmic examination that may require general anesthesia, and carefully selected investigations. Infections and masquerade syndromes, such as leukemia and retinoblastoma, must be excluded before treatment is commenced with immunosuppressive agents. Noninfectious anterior uveitis generally responds to topical corticosteroid and mydriatic therapy. Although used frequently in adults with posterior uveitis, periocular corticosteroid injections may require a general anesthetic, and systemic corticosteroids may cause serious adverse effects, including growth retardation, in pediatric patients. Consequently, in children, one or more corticosteroid-sparing immunosuppressive drugs are usually employed for vision-threatening noninfectious posterior eye inflammation. Methotrexate is the most commonly used systemic immunosuppressive agent for pediatric uveitis. It is effective in small retrospective clinical series, generally well tolerated, easy to administer, and inexpensive. Cyclosporin has also been used successfully in children with uveitis, being associated with a low risk of renal toxicity when used at standard doses. Although prescribed for severe ocular inflammation in adults, alkylating agents are generally contraindicated in children owing to risks including secondary malignancy, sterility and bone marrow suppression. Drugs that inhibit tumor necrosis factor-alpha have recently been used successfully to treat children with uveitis; however, in some patients there may be a risk of potentiating the ocular inflammation. Randomized clinical trials would provide valuable information about the relative efficacy of the various available treatment options.
葡萄膜炎是指累及葡萄膜或眼球中层的炎症。这种病症并不常见，尤其在16岁及以下人群中。然而，儿童葡萄膜炎因其预后相对较差、独特的全身关联以及各种与年龄相关的治疗考量等原因，值得特别关注。准确诊断需要患者及其父母提供病史、可能需要全身麻醉的全面眼科检查以及精心挑选的检查项目。在开始使用免疫抑制剂治疗之前，必须排除感染和伪装综合征，如白血病和视网膜母细胞瘤。非感染性前葡萄膜炎通常对局部使用皮质类固醇和散瞳剂治疗有反应。尽管眼周注射皮质类固醇在成人后葡萄膜炎中经常使用，但在儿科患者中可能需要全身麻醉，且全身使用皮质类固醇可能会引起严重不良反应，包括生长发育迟缓。因此，对于威胁视力的非感染性后眼部炎症，儿童通常使用一种或多种节省皮质类固醇的免疫抑制药物。甲氨蝶呤是儿科葡萄膜炎最常用的全身免疫抑制剂。在小型回顾性临床系列研究中它是有效的，一般耐受性良好，易于给药且价格低廉。环孢素也已成功用于患有葡萄膜炎的儿童，以标准剂量使用时肾毒性风险较低。尽管烷化剂在成人严重眼部炎症中会被使用，但由于存在继发恶性肿瘤、不育和骨髓抑制等风险，儿童一般禁用。抑制肿瘤坏死因子-α的药物最近已成功用于治疗患有葡萄膜炎的儿童；然而，在一些患者中可能存在增强眼部炎症的风险。随机临床试验将提供有关各种可用治疗方案相对疗效的有价值信息。
