Costet C, Andrèbe C, Paya C, Pillet P, Richer O, Rougier M B, Korobelnik J F, Coste V
Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
J Fr Ophtalmol. 2019 May;42(5):441-450. doi: 10.1016/j.jfo.2018.09.008. Epub 2019 Apr 9.
To evaluate the medical-surgical management of cataract surgery in children with chronic uveitis in various French pediatric ophthalmology centers.
Two-part study: first, a descriptive observational segment on the evaluation of French practices. A questionnaire was sent to the various pediatric ophthalmologists in France. A second retrospective chart review, including children with non-infectious chronic uveitis who had cataract surgery in the pediatric ophthalmology department of Bordeaux University Hospital from 2008 to 2017.
Twenty-one ophthalmologists responded to the questionnaire. Only 23.8% systematically initiated immunosuppressive drugs (aside from corticosteroids) before surgery. A total of 88.2% prescribed oral corticosteroid treatment preoperatively. Eleven surgeons administered intravenous corticosteroid boluses during the surgery, and primary lens implantation is the most common method used in 95.2%. A total of 76.2% initiated oral steroid therapy after surgery. Postoperatively, all surgeons started local therapy with high-dose corticosteroids. At one year, 100% achieved improvement of visual acuity greater than or equal to 2 lines. On our service, 10 eyes (7 children) underwent cataract surgery. Seven were treated with systemic immunosuppressive drugs (aside from corticosteroids) and 80% of cases received oral corticosteroid therapy a few days before surgery. An intravenous corticosteroid bolus was administered preoperatively in 8 cases, and primary lens implantation was performed in 100% of cases. Postoperatively, 5 children received oral corticosteroid treatment. All were treated with local high dose steroids. At one year, the mean best-corrected visual acuity was 0.18 LogMar (0-0.7, SD: 0.25).
When performed with an aggressive anti-inflammatory protocol, cataract surgery leads to a good visual outcome in selected children with chronic uveitis.
评估法国各儿科眼科中心对患有慢性葡萄膜炎儿童进行白内障手术的内科及外科治疗情况。
分为两部分研究：首先，进行一项关于法国实际治疗情况评估的描述性观察研究。向法国各地的儿科眼科医生发放问卷。其次，进行回顾性病历审查，纳入2008年至2017年在波尔多大学医院儿科眼科接受白内障手术的非感染性慢性葡萄膜炎患儿。
21位眼科医生回复了问卷。只有23.8%的医生在手术前常规使用免疫抑制药物（不包括皮质类固醇）。共有88.2%的医生在术前开具口服皮质类固醇治疗。11位外科医生在手术期间给予静脉注射皮质类固醇大剂量冲击治疗，95.2%的医生最常采用一期晶状体植入术。共有76.2%的医生在术后开始口服类固醇治疗。术后，所有外科医生均开始使用高剂量皮质类固醇进行局部治疗。一年时，100%的患儿视力提高了至少2行。在我们科室，10只眼（7名儿童）接受了白内障手术。7名患儿接受了全身性免疫抑制药物治疗（不包括皮质类固醇），80%的病例在手术前几天接受了口服皮质类固醇治疗。8例患儿在术前给予静脉注射皮质类固醇大剂量冲击治疗，100%的病例进行了一期晶状体植入术。术后，5名儿童接受了口服皮质类固醇治疗。所有患儿均接受了局部高剂量类固醇治疗。一年时，平均最佳矫正视力为0.18 LogMar（0 - 0.7，标准差：0.25）。
当采用积极的抗炎方案进行白内障手术时，对于选定的慢性葡萄膜炎儿童可取得良好的视力预后。
