Department of Ophthalmology "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania; Department of Ophthalmology, County Emergency Hospital, Cluj-Napoca, Romania.
Pediatrics I Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania.
Rom J Ophthalmol. 2022 Apr-Jun;66(2):185-190. doi: 10.22336/rjo.2022.36.
Anterior uveitis is the most common extra-articular manifestation in children diagnosed with Juvenile idiopathic arthritis (JIA). It is typically a non-granulomatous, chronic, and asymptomatic uveitis. The lack of acute symptoms often delays the diagnosis with the incidence of severe ocular complications. Chorioretinitis lesions have been described in only 1% of cases. The absence of fundus changes can be explained by the impossibility of performing fundoscopy through the cloudy ocular media, secondary to inflammation. A 7-year-old female with a 3-month history of painless reduced vision came to have an eye examination. An initial diagnosis of bilateral anterior granulomatous uveitis complicated with glaucoma and cataract was formulated. Because of the concomitant diagnosis of COVID-19 disease (same day as the eye examination), the child was hospitalized in a hometown COVID-19 patient ward, so both local and general treatment, monitorization, and investigations were discontinued. The following eye examination revealed the persistence of anterior uveitis, inflammatory glaucoma, cataract, and the appearance of band keratopathy. Fundoscopy revealed numerous disseminated lesions of choroiditis. Further examinations established JIA-associated uveitis diagnosis, so systemic corticosteroids were initiated followed by Methotrexate and Adalimumab. . BVA = best visual acuity, CVA = corrected visual acuity, CS = corticosteroids, IOP = Intraocular pressure, JIA = Juvenile idiopathic arthritis, JIA-U = Juvenile idiopathic arthritis associated uveitis, LE = left eye, MTX = Methotrexate, OU = both eyes, OCT = Optical Coherence Tomography, RE = right eye, TNF = tumor necrosis factor.
前葡萄膜炎是儿童幼年特发性关节炎（JIA）诊断中最常见的关节外表现。它通常是一种非肉芽肿性、慢性和无症状的葡萄膜炎。缺乏急性症状常导致诊断延迟，出现严重眼部并发症。脉络膜炎病变仅在 1%的病例中描述过。眼底无变化可以解释为炎症导致混浊的眼内介质妨碍进行眼底检查。一名 7 岁女性，3 个月来出现无痛性视力下降，来进行眼部检查。最初诊断为双侧前肉芽肿性葡萄膜炎，伴有青光眼和白内障。由于同时诊断为 COVID-19 疾病（与眼部检查同日），患儿被收治在当地 COVID-19 患者病房，因此局部和全身治疗、监测和检查都停止了。随后的眼部检查显示仍存在前葡萄膜炎、炎症性青光眼、白内障和带状角膜病变。眼底镜检查显示脉络膜炎有许多弥散性病变。进一步检查确定了 JIA 相关性葡萄膜炎的诊断，因此开始使用全身皮质类固醇，随后使用甲氨蝶呤和阿达木单抗。BVA = 最佳视力，CVA = 矫正视力，CS = 皮质类固醇，IOP = 眼内压，JIA = 幼年特发性关节炎，JIA-U = 幼年特发性关节炎相关性葡萄膜炎，LE = 左眼，MTX = 甲氨蝶呤，OU = 双眼，OCT = 光学相干断层扫描，RE = 右眼，TNF = 肿瘤坏死因子。
