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Klin Monbl Augenheilkd 2018; 235(04): 373-376
DOI: 10.1055/s-0043-123650
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Macular Edema in Childhood Uveitis

Makulaödem bei kindlicher Uveitis
Justus G. Garweg
Clinic for Uveitis, Berner Augenklinik am Lindenhofspital, University of Bern, Bern, Switzerland
› Author Affiliations
Further Information

Publication History

received 24 September 2017

accepted 12 November 2017

Publication Date:
16 February 2018 (online)

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Abstract

Background Pediatric uveitis is associated with a high incidence of severe and frequently permanent visual loss. This article summarizes the current understanding of the disease and the therapeutic options that are available to improve treatment outcomes.

Methods A Medline search spanning the last 10 years was undertaken using the key terms “pediatric uveitis” or “childhood uveitis” and “macular edema”. Articles which appertained to case reports or small case series were excluded from consideration, whereas those in which the opinions of experts were expressed, as well as reviews, were not. The information contained in these latter two forms of publication was particularly valuable, owing to the scarcity of prospective clinical data appertaining to the treatment of pediatric uveitis-associated macular edema.

Results Ten years ago, 34% of children who presented with uveitis manifested secondary complications at the time of diagnosis. During the ensuing 3 years of treatment, this rose to 86%. Heightening awareness of the disease with earlier referrals to expert centers, as well as the advent of therapeutic strategies involving anti-TNF agents and intravitreal corticosteroids, have led to a decrease in the incidence of legal blindness in the affected eyes from 18 – 69% to below 8% during a five-year course of treatment.

Conclusion Early diagnosis and strict control of inflammatory activity have led to a dramatic reduction in the incidence of vision-threatening secondary complications. In the majority of cases, it has also been possible to resolve cystoid macular edema, which, if insufficiently controlled by systemic therapy, usually responds well to intravitreal dexamethasone implants.

Zusammenfassung

Hintergrund Das Risiko eines schweren und bleibenden Sehverlustes ist bei kindlicher Uveitis besonders hoch. In diesem Artikel werden deshalb die der schlechten Prognose zugrunde liegenden Mechanismen und die modernen Behandlungsmöglichkeiten dargestellt, mit denen sich erstaunlich gute Langzeitresultate erreichen lassen.

Methoden Grundlage für diese Übersicht bildet eine Medline-Suche mit den Suchbegriffen „pädiatrische Uveitis“ oder „kindliche Uveitis“ und „Makula-Oedem“. Unter den Artikeln der letzten 10 Jahre wurden Fallberichte und kleine Fallserien ausgeschlossen; Übersichtsartikel mit Expertenmeinungen wurden berücksichtigt, da kaum prospektives Datenmaterial zur Behandlung der kindlichen Uveitis und des mit ihr vergesellschafteten entzündlichen Makulaödems existiert.

Ergebnisse Bis vor 10 Jahren zeigten 34% der Kinder bereits bei der Diagnosestellung Sekundärkomplikationen ihrer Uveitis. Trotz Behandlung stieg der Anteil an Augen mit Sekundärkomplikationen im Verlauf von 3 Jahren auf 86% an. Ein verbessertes Problembewusstsein und die frühere Überweisung der Kinder an spezialisierte Zentren hat einen früheren Einsatz moderner immunmodulierender Therapien, insbesondere Biologika und intravitrealer Depotsteroide, ermöglicht, wodurch das Risiko eines Visusabfalls der betroffenen Augen auf unter 0,1 von 18 – 69% auf unter 8% gesunken ist.

Schlussfolgerungen Eine frühzeitige Diagnose und konsequente Behandlung der kindlichen Uveitis haben zu einer erstaunlichen Reduktion der Häufigkeit von Sekundärkomplikationen geführt. Fast immer gelingt es, ein entzündliches Makulaödem zu kontrollieren, wenn bei nicht ausreichendem Ansprechen auf die systemische immunmodulierende Therapie auch intravitreale Dexamethason-Implantationen eingesetzt werden.

Key words

pediatric uveitis - macular edema - vision loss - complications - intraocular inflammations - pediatric ophthalmology

Schlüsselwörter

intraokulare Entzündungen - Kinderophthalmologie - Makulaödem - kindliche Uveitis - Komplikationen - Sehverlust
 

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