Division of Immunology, Boston Children's Hospital, Harvard Medical School, Fegan 6, 300 Longwood Avenue, Boston, MA 02115, USA.
Department of Ophthalmology, Emory University, Emory Eye Center, 1365 Clifton Road, Clinic Building B, Atlanta, GA 30326, USA.
Rheum Dis Clin North Am. 2021 Nov;47(4):619-641. doi: 10.1016/j.rdc.2021.07.005. Epub 2021 Aug 27.
Childhood noninfectious uveitis leads to sight-threatening complications. Idiopathic chronic anterior uveitis and juvenile idiopathic arthritis-associated uveitis are most common. Inflammation arises from an immune response against antigens within the eye. Ophthalmic work-up evaluates anatomic involvement, disease activity, ocular complications, and disease course. Local and/or systemic glucocorticoids are initial treatment, but not as long-term sole therapy to avoid glucocorticoids-induced toxicity or persistent ocular inflammation. Children with recurrent, refractory, or severe disease require systemic immunosuppression with methotrexate and/or anti-tumor necrosis factor monoclonal antibody medications (adalimumab, infliximab). Goals of early detection and treatment are to optimize vision in childhood uveitis.
儿童非感染性葡萄膜炎可导致威胁视力的并发症。特发性慢性前葡萄膜炎和与幼年特发性关节炎相关的葡萄膜炎最为常见。炎症是由针对眼内抗原的免疫反应引起的。眼科检查评估解剖学受累、疾病活动度、眼部并发症和疾病进程。局部和/或全身糖皮质激素是初始治疗方法，但不作为长期单一治疗方法，以避免糖皮质激素引起的毒性或持续的眼部炎症。对于反复、难治或严重的疾病患儿，需要使用甲氨蝶呤和/或抗肿瘤坏死因子单克隆抗体药物（阿达木单抗、英夫利昔单抗）进行全身免疫抑制治疗。早期发现和治疗的目标是优化儿童葡萄膜炎的视力。
