Department of Ophthalmology, Royal Victoria Hospital, 274 Grosvenor Road, BT12 6BA, Belfast, UK.
Centre for Experimental Medicine, Queens University of Belfast, BT9 7BL, Belfast, UK.
Eye (Lond). 2019 Mar;33(3):380-384. doi: 10.1038/s41433-018-0214-0. Epub 2018 Sep 18.
BACKGROUND/OBJECTIVES: Uveitis is an uncommon manifestation of post-streptococcal syndrome (PSUS). Despite reports, the condition is often not well recognised. The purpose of this study is to report a case series of children with post-streptococcal uveitis.
SUBJECTS/METHODS: In this retrospective case series, all cases of PSUS were identified from all new paediatric patients diagnosed with uveitis over a 6-year period. Diagnosis of PSUS was based on the following diagnostic criteria: unilateral or bilateral uveitis with positive anti-streptolysin O titres (ASOT) or anti-deoxyribonuclease (anti-DNase) titres, and negative routine investigations for other causes of uveitis.
Eleven Caucasian paediatric patients were diagnosed with PSUS. One had a novel finding of peripheral corneal endotheliopathy, 73% of patients presented in spring or winter months and 88% of eyes had a final VA of better than or equal to 6/12 at a mean follow-up of 22 months. Systemic immunosuppressant treatment was used in 36% of patients. Adalimumab was used in 18% of patient's refractory to other treatment.
We report on the largest consecutive series of Caucasian patients under 16 years of age with PSUS. We have demonstrated a seasonal preponderance with presentation typically in winter or spring. We report a novel finding of corneal endotheliopathy in one of our PSUS patients. We also report on the benefit of adalimumab in the management of severe cases of PSUS; use of biologics in this particular cohort of uveitis patients has not previously been reported. With aggressive treatment our patients achieved good visual outcomes comparable to other published series.
背景/目的：葡萄膜炎是链球菌后综合征（PSUS）的一种罕见表现。尽管有报道，但这种情况通常未得到很好的认识。本研究的目的是报告一系列患有链球菌后葡萄膜炎的儿童病例。
对象/方法：在这项回顾性病例系列研究中，从 6 年内所有新诊断为葡萄膜炎的儿科患者中确定了所有 PSUS 病例。PSUS 的诊断基于以下诊断标准：单侧或双侧葡萄膜炎，抗链球菌溶血素 O 滴度（ASOT）或抗脱氧核糖核酸酶（抗-DNase）滴度阳性，且常规检查排除其他葡萄膜炎病因。
11 名白人儿科患者被诊断为 PSUS。其中 1 例出现周边角膜内皮病变的新发现，73%的患者在春季或冬季就诊，88%的眼在平均 22 个月的随访中最终视力≥6/12。36%的患者接受了全身免疫抑制剂治疗。18%的患者对其他治疗无效，使用了阿达木单抗。
我们报告了最大的连续系列白人 16 岁以下 PSUS 患者病例。我们发现了季节性发病倾向，典型的发病季节为冬季或春季。我们报告了 1 例 PSUS 患者的角膜内皮病变新发现。我们还报告了阿达木单抗在严重 PSUS 管理中的益处；在这组特定的葡萄膜炎患者中，生物制剂的使用以前没有报道过。通过积极治疗，我们的患者获得了与其他已发表系列相当的良好视力结局。
