Uveitis im Kindesalter

Zusammenfassung

Die Uveitis im Kindesalter ist eine ophthalmologische Herausforderung, da sie einerseits häufig symptomlos bleibt und schwer zu erkennen ist und andererseits vielfach chronisch verläuft sowie mit einem hohen Risiko für visusbedrohende Komplikationen behaftet ist. Die wichtigsten Risikofaktoren für eine Uveitis im Kindesalter sind rheumatische Grunderkrankungen; gemeinsam mit den Kinderrheumatologen wurden Empfehlungen für die ophthalmologische Überwachung erarbeitet. Intermediäre und posteriore Uveitiden sind bei Kindern selten. Die Therapie muss Entzündung effektiv kontrollieren können, darf aber gleichzeitig nur ein Minimum an Nebenwirkungen verursachen. Da gerade die Steroide häufig Nebenwirkungen verursachen, muss frühzeitig in interdisziplinäre Zusammenarbeit mit Kinderrheumatologen und Eltern eine immunsuppressive Therapie mit dem Ziel der Steroidminimierung eingeleitet werden.

Schlüsselwörter

Uveitis - Kinderophthalmologie - Therapie

• References/Literatur

• 1 Paroli MP, Spinucci G, Liverani M. et al. Uveitis in childhood: an Italian clinical and epidemiological study. Ocul Immunol Inflamm 2009; 17: 238-242
• 2 Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005; 140: 509-516
• 3 Heiligenhaus A, Minden K, Tappeiner C. et al. Leitlinie 045-012, S2k, Diagnostik und antientzündliche Therapie der Uveitis bei juveniler idiopathischer Arthritis. 2018 Accessed September 6, 2020 at: https://www.awmf.org/leitlinien/detail/ll/045-012.html
• 4 Heiligenhaus A, Minden K, Tappeiner C. et al. Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Semin Arthritis Rheum 2019; 49: 43-55
• 5 LaMattina KC, Koreishi AF. What is new in paediatric uveitis?. Curr Opin Ophthalmol 2018; 29: 412-418
• 6 Petty RE, Southwood TR, Manners P. et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31: 390-392
• 7 Khochtali S, Abroug N, Megzari K. et al. Swept-source optical coherence tomography angiography findings in uveitic cystoid macular edema. Ocul Immunol Inflamm 2019; 27: 1211-1223
• 8 Sancho L, Kramer M, Koriat A. et al. Complications in intermediate uveitis: prevalence, time of onset, and effects on vision in short-term and long-term follow-up. Ocul Immunol Inflamm 2019; 27: 447-455
• 9 Engelhard SB, Bajwa A, Reddy AK. Causes of uveitis in children without juvenile idiopathic arthritis. Clin Ophthalmol 2015; 9: 1121-1128
• 10 Poddighe D, Mukusheva Z, Dauyey K. et al. Adalimumab in the treatment of pediatric Behcetʼs disease: case-based review. Rheumatol Int 2019; 39: 1107-1112
• 11 Diwo E, Gueudry J, Saadoun D. et al. Long-term efficacy of interferon in severe uveitis associated with Behçet disease. Ocul Immunol Inflamm 2017; 25: 76-84
• 12 Guillaume-Czitrom S, Berger C, Pajot C. et al. Efficacy and safety of interferon-alpha in the treatment of corticodependent uveitis of paediatric Behcetʼs disease. Rheumatology (Oxford) 2007; 46: 1570-1573
• 13 Morelle G, Gueudry J, Uettwiller F. et al. Chronic and recurrent non-infectious paediatric-onset uveitis: a French cohort. RMD Open 2019; 5: e000933
• 14 Smith JA, Mackensen F, Sen HN. et al. Epidemiology and course of disease in childhood uveitis. Ophthalmology 2009; 116: 1544-1551 1551.e1
• 15 Gordon KB, Rugo HS, Duncan JL. et al. Ocular manifestations of leukemia. Leukemic infiltration versus infectious process. Ophthalmology 2001; 108: 2293-2300
• 16 Ramanan AV, Dick AD, Benton D. et al. A randomised controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis (SYCAMORE Trial). Trials 2014; 15: 14
• 17 Calvo-Río V, Santos-Gómez M, Calvo I. et al. Anti-interleukin-6 receptor tocilizumab for severe juvenile idiopathic arthritis-associated uveitis refractory to anti-tumor necrosis factor therapy: A multicenter study of twenty-five patients. Arthritis Rheumatol 2017; 69: 668-675
• 18 Tappeiner C, Mesquida M, Adan A. et al. Evidence for tocilizumab as a treatment option in refractory uveitis associated with juvenile idiopathic arthritis. J Rheumatol 2016; 43: 2183-2188
• 19 Horneff G, Klein A, Klotsche J. et al. Comparison of treatment response, remission rate and drug adherence in polyarticular juvenile idiopathic arthritis patients treated with etanercept, adalimumab or tocilizumab. Arthritis Res Ther 2016; 18: 272
• 20 Adan A, Mesquida M, Llorenc V. et al. Tocilizumab treatment for refractory uveitis-related cystoid macular edema. Graefes Arch Clin Exp Ophthalmol 2013; 251: 2627-2632
• 21 Vegas-Revenga N, Calvo-Rio V, Mesquida M. et al. Anti-IL6-receptor tocilizumab in refractory and noninfectious uveitic cystoid macular edema: Multicenter study of 25 patients. Am J Ophthalmol 2019; 200: 85-94
• 22 Heiligenhaus A, Miserocchi E, Heinz C. et al. Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab). Rheumatology 2011; 50: 1390-1394
• 23 Tappeiner C, Klotsche J, Schenck S. et al. Temporal change in prevalence and complications of uveitis associated with juvenile idiopathic arthritis: data from a cross-sectional analysis of a prospective nationwide study. Clin Exp Rheumatol 2015; 33: 936-944
• 24 Lowder C, Belfort R, Lightman S. et al. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol 2011; 129: 545-553
• 25 Winterhalter S, Niehues T. TNFalpha-blocking agents or conventional immunosuppressive drugs in the therapy of children with uveitis? – An evidence based approach. Klin Padiatr 2008; 220: 342-347
• 26 Jabs DA. Immunosuppression for the uveitides. Ophthalmology 2018; 125: 193-202
• 27 Li SY, Birnbaum AD, Goldstein DA. Optic neuritis associated with adalimumab in the treatment of uveitis. Ocul Immunol Inflamm 2010; 18: 475-481
• 28 Shahab MA, Mir TA, Zafar S. Optimising drug therapy for non-infectious uveitis. Int Ophthalmol 2019; 39: 1633-1650
• 29 Bratton ML, He YG, Weakley DR. Dexamethasone intravitreal implant (Ozurdex) for the treatment of pediatric uveitis. J AAPOS 2014; 18: 110-113
• 30 Totan Y, Güler E, Guragaç FB. et al. Cystoid macular edema associated with juvenile idiopathic arthritis resolved by a dexamethasone intravitreal implant. J Pediatr Ophthalmol Strabismus 2014; 51: e25-e28
• 31 Garweg JG. Macular edema in childhood uveitis. Klin Monbl Augenheilkd 2018; 235: 373-376
• 32 Grajewski RS, Zurek-Imhoff B, Roesel M. et al. Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis. Acta Ophthalmol 2012; 90: 657-662
• 33 Angeles-Han ST, McCracken C, Yeh S. et al. Characteristics of a cohort of children with juvenile idiopathic arthritis and JIA-associated uveitis. Pediatr Rheumatol Online J 2015; 13: 19
• 34 Oray M, Khachatryan N, Ebrahimiadib N. et al. Ocular morbidities of juvenile idiopathic arthritis-associated uveitis in adulthood: results from a tertiary center study. Graefes Arch Clin Exp Ophthalmol 2016; 254: 1841-1849
• 35 Al-Haddad C, BouGhannam A, Abdul Fattah M. et al. Patterns of uveitis in children according to age: comparison of visual outcomes and complications in a tertiary center. BMC Ophthalmol 2019; 19: 137
• 36 Rathi VM, Vyas SP, Vaddavalli PK. et al. Phototherapeutic keratectomy in pediatric patients in India. Cornea 2010; 29: 1109-1112
• 37 Blum-Hareuveni T, Seguin-Greenstein S, Kramer M. et al. Risk factors for the development of cataract in children with uveitis. Am J Ophthalmol 2017; 177: 139-143
• 38 Moradi A, Stroh IG, Reddy AK. et al. Risk of hypotony in juvenile idiopathic arthritis-associated uveitis. Am J Ophthalmol 2016; 169: 113-124
• 39 Thorne JE, Woreta FA, Dunn JP. et al. Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology 2010; 117: 1436-1441
• 40 Yangzes S, Seth NG, Singh R. et al. Long-term outcomes of cataract surgery in children with uveitis. Indian J Ophthalmol 2019; 67: 490-495
• 41 Kulik U, Wiklund A, Kugelberg M. et al. Long-term results after primary intraocular lens implantation in children with juvenile idiopathic arthritis-associated uveitis. Eur J Ophthalmol 2019; 29: 494-498
• 42 Jinagal J, Gupta G, Agarwal A. et al. Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis. Indian J Ophthalmol 2019; 67: 69-74
• 43 Kothari S, Foster CS, Pistilli M. et al. The risk of intraocular pressure elevation in pediatric noninfectious uveitis. Ophthalmology 2015; 122: 1987-2001
• 44 Gautam Seth N, Yangzes S, Thattaruthody F. et al. Glaucoma secondary to uveitis in children in a tertiary care referral center. Ocul Immunol Inflamm 2019; 27: 456-464
• 45 Hayasaka Y, Hayasaka S, Zhang XY. et al. Effects of topical antiglaucoma eye drops on prostaglandin E(2)-induced aqueous flare elevation in pigmented rabbits. Invest Ophthalmol Vis Sci 2002; 43: 1142-1145
• 46 Fechtner RD, Khouri AS, Zimmerman TJ. et al. Anterior uveitis associated with latanoprost. Am J Ophthalmol 1998; 126: 37-41 doi:10.1016/s0002-9394(98)00071-3
• 47 Halpern DL, Pasquale LR. Cystoid macular edema in aphakia and pseudophakia after use of prostaglandin analogs. Semin Ophthalmol 2002; 17: 181-186
• 48 Wiese C, Heiligenhaus AM, Heinz CMF. Changes in inflammatory activity after glaucoma filtration surgery in children with chronic anterior uveitis. Ocul Immunol Inflamm 2016; 24: 397-401 doi:10.3109/09273948.2015.1088041
• 49 Böhm MR, Tappeiner C, Breitbach MA. et al. Ocular hypotony in patients with juvenile idiopathic arthritis-associated uveitis. Am J Ophthalmol 2017; 173: 45-55
• 50 Sen HN, Drye LT, Goldstein DA. et al. Hypotony in patients with uveitis: The Multicenter Uveitis Steroid Treatment (MUST) trial. Ocul Immunol Inflamm 2012; 20: 104-112
• 51 Loh AR, Acharya NR. Incidence rates and risk factors for ocular complications and vision loss in HLA-B27-associated uveitis. Am J Ophthalmol 2010; 150: 534-542.e2
• 52 Tran VT, Mermoud A, Herbort CP. Appraisal and management of ocular hypotony and glaucoma associated with uveitis. Int Ophthalmol Clin 2000; 40: 175-203
• 53 Eiger-Moscovich M, Tomkins-Netzer O, Amer R. et al. Visual and clinical outcome of macular edema complicating pediatric noninfectious uveitis. Am J Ophthalmol 2019; 202: 72-78
• 54 Miraldi Utz V, Bulas S, Lopper S. et al. Effectiveness of long-term infliximab use and impact of treatment adherence on disease control in refractory, non-infectious pediatric uveitis. Pediatr Rheumatol Online J 2019; 17: 79