Osswald D, Rameau A C, Speeg-Schatz C, Terzic J, Sauer A
Service d'ophtalmologie, université de Strasbourg, hôpitaux universitaires de Strasbourg, nouvel hôpital civil, BP 426, 67091 Strasbourg, France.
Service de pédiatrie, université de Strasbourg, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 67098 Strasbourg, France.
J Fr Ophtalmol. 2018 May;41(5):447-452. doi: 10.1016/j.jfo.2017.09.016. Epub 2018 May 18.
Uveitis is the leading cause of acquired childhood blindness with a prevalence of 30 cases per 100,000 inhabitants. There are multiple causes ; nevertheless, there is no standardized etiological assessment. The goal of our study is to define an epidemiological and clinical profile of uveitis diagnosed in a university hospital and their course when treated with anti-tumor necrosis factor (TNF) α.
All cases of uveitis under 18 years old, from 1994 to 2016, were included. Post-traumatic, post-surgical, pseudo-uveitis and retinopathy of prematurity were excluded. Demographic data, patient history, initial ophthalmological status, etiologic assessment data and treatments already underway were collected.
Ninety cases of pediatric uveitis were included, among which were 16.7 % infectious uveitis, 38.9 % inflammatory uveitis and 44.4 % idiopathic uveitis. Etiologic investigations were considered incomplete in 45 % of idiopathic uveitis cases. Treatment with anti-TNFα was selected for 15.5 % of patients. In total, 33 % of patients treated with etanercept required other anti-TNFα drugs due to a lack of control of inflammation. Infliximab and adalimumab successfully managed to control inflammation in 28.6 % of cases each.
Diagnostic criteria based adult systemic disease are sometimes inappropriate for children. The advent of anti-TNFα appears to improve the visual prognosis of inflammatory uveitis resistant to conventional immunosuppressant therapy, but we still need to perfect protocols for their use.
There are neither standardized etiological assessment nor clear diagnostic and therapeutic protocols for children. TNFα inhibitors are more effective in controlling inflammation in severe pediatric uveitis.
葡萄膜炎是儿童后天性失明的主要原因，每10万居民中患病率为30例。病因多种多样；然而，目前尚无标准化的病因评估方法。我们研究的目的是确定在一家大学医院诊断出的葡萄膜炎的流行病学和临床特征，以及使用抗肿瘤坏死因子（TNF）α治疗后的病程。
纳入1994年至2016年间所有18岁以下的葡萄膜炎病例。排除创伤后、手术后、假性葡萄膜炎和早产儿视网膜病变。收集人口统计学数据、患者病史、初始眼科状况、病因评估数据和已进行的治疗。
纳入90例儿童葡萄膜炎病例，其中感染性葡萄膜炎占16.7%，炎性葡萄膜炎占38.9%，特发性葡萄膜炎占44.4%。45%的特发性葡萄膜炎病例病因调查被认为不完整。15.5%的患者选择使用抗TNFα治疗。总体而言，由于炎症控制不佳，33%接受依那西普治疗的患者需要使用其他抗TNFα药物。英夫利昔单抗和阿达木单抗分别在28.6%的病例中成功控制了炎症。
基于成人全身疾病的诊断标准有时不适用于儿童。抗TNFα的出现似乎改善了对传统免疫抑制治疗耐药的炎性葡萄膜炎的视觉预后，但我们仍需完善其使用方案。
儿童既没有标准化的病因评估，也没有明确的诊断和治疗方案。TNFα抑制剂在控制重度儿童葡萄膜炎的炎症方面更有效。
