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一例幼年特发性关节炎日本患儿白内障术后用阿达木单抗长期控制黄斑水肿:病例报告和 26 例日本患者的回顾性分析。

Long-Term Control of Macular Edema With Adalimumab After Cataract Surgery in a Japanese Child With Juvenile Idiopathic Arthritis: Case Report and Review of 26 Japanese Patients.

机构信息

Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama City, Japan.

Ophthalmology, Okayama University Hospital and Okayama University Medical School, Okayama City, Japan.

出版信息

J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620953283. doi: 10.1177/2324709620953283.

Abstract

Juvenile idiopathic arthritis-associated uveitis is rare in the Japanese population. In this article, we report a child whose macular edema was controlled for years after cataract surgery with adalimumab, and reviewed 26 Japanese patients in the literature. In this case report, a 4-year-old boy developed band keratopathy, posterior iris synechiae, and complicated cataract in both eyes. Oral prednisolone prescribed at another hospital was discontinued due to high intraocular pressure in both eyes as a steroid responder. At the age of 5 years, he started oral methotrexate 8 mg weekly for recurrent bilateral iridocyclitis and then underwent lensectomy with core vitrectomy in both eyes. Planned intraocular lens implantation was cancelled at surgery because the anterior vitreous had severe inflammatory opacity with diffuse retinal edema in both eyes. Due to persistent macular edema in both eyes 5 months postoperatively, at the age of 6 years, he began to use adalimumab injection 20 mg every 2 weeks. The macular structure depicted by optical coherence tomography became normal in 2 months. At final visit at the age of 11 years, he had the best-corrected visual acuity of 0.8 in the right eye and 0.4 in the left eye, with adalimumab 40 mg every 2 weeks and methotrexate 8 mg weekly. In conclusion, macular edema persistent despite oral methotrexate after cataract surgery could be controlled for long term by adalimumab in a child with juvenile idiopathic arthritis. In the Japanese literature, only 26 additional cases with juvenile idiopathic arthritis-associated uveitis have been reported so far.

摘要

幼年特发性关节炎相关性葡萄膜炎在日本人群中较为罕见。本文报告了一例儿童患者,在接受阿达木单抗治疗后,其白内障手术后的黄斑水肿多年来得到了控制,并对文献中的 26 例日本患者进行了综述。在本病例报告中,1 名 4 岁男孩双眼均出现了带状角膜病变、后发性虹膜粘连和并发性白内障。由于双眼眼内压升高,另一所医院开的口服泼尼松龙被停用,该患者为类固醇反应者。5 岁时,因双眼复发性虹膜睫状体炎,开始口服每周 8mg 甲氨蝶呤,随后双眼行晶状体切除术联合核心玻璃体切除术。由于双眼前部玻璃体严重炎症混浊伴弥漫性视网膜水肿,计划在手术中植入人工晶状体被取消。术后 5 个月,因双眼黄斑水肿持续存在,6 岁时开始每 2 周使用阿达木单抗注射 20mg。2 个月后,光学相干断层扫描显示黄斑结构恢复正常。11 岁时最终随访时,右眼最佳矫正视力为 0.8,左眼为 0.4,阿达木单抗每 2 周 40mg,甲氨蝶呤每周 8mg。总之,在接受白内障手术后,即使口服甲氨蝶呤,仍有持续性黄斑水肿,阿达木单抗可在患有幼年特发性关节炎的儿童中实现长期控制。迄今为止,在日本文献中仅报道了另外 26 例与幼年特发性关节炎相关的葡萄膜炎病例。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb3b/7457411/89ee0c81180d/10.1177_2324709620953283-fig1.jpg

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