TY - JOUR
T1 - The role of vitreo-retinal surgery in children with uveitis
AU - Arevalo, J. Fernando
AU - Garcia-Amaris, Rafael A.
PY - 2008/6/1
Y1 - 2008/6/1
N2 - Uveitis in children has been reported at a much lower incidence than in adults, although with worse prognosis because at the time of diagnosis a substantial number of patients have complications that represent an important cause of ocular morbidity and visual loss. Children may be at special risk of complications, because inflammation is frequently chronic, and diagnosis is often delayed because of lack of symptoms or failure to report changes in vision. In addition, children are more difficult to examine and to treat. The evaluation and management of children with uveitis require special considerations. Medical and surgical management can be challenging owing to the unique features of clinical presentation. Therefore, early and aggressive anti-inflammatory therapy is the best means to improved long-term outcomes in children. Surgical intervention for diagnostic or therapeutic reasons may be necessary, and generally is required to address complications that are unresponsive to or not amenable to medical therapy. In addition, surgical procedures must be appropriately planned keeping in mind the risks and benefits and always under an appropriate and strict immunosuppressive (preoperative, intraoperative, and postoperative) therapy. Surgical treatment should be considered only when uveitis is controlled medically. Multistage surgery may be necessary to address each complication of uveitis using diverse strategies. Finally, a close relation should be fostered among pediatricians, pediatric rheumatologist, and ophthalmologist to more effectively diagnose and manage children with uveitis.
AB - Uveitis in children has been reported at a much lower incidence than in adults, although with worse prognosis because at the time of diagnosis a substantial number of patients have complications that represent an important cause of ocular morbidity and visual loss. Children may be at special risk of complications, because inflammation is frequently chronic, and diagnosis is often delayed because of lack of symptoms or failure to report changes in vision. In addition, children are more difficult to examine and to treat. The evaluation and management of children with uveitis require special considerations. Medical and surgical management can be challenging owing to the unique features of clinical presentation. Therefore, early and aggressive anti-inflammatory therapy is the best means to improved long-term outcomes in children. Surgical intervention for diagnostic or therapeutic reasons may be necessary, and generally is required to address complications that are unresponsive to or not amenable to medical therapy. In addition, surgical procedures must be appropriately planned keeping in mind the risks and benefits and always under an appropriate and strict immunosuppressive (preoperative, intraoperative, and postoperative) therapy. Surgical treatment should be considered only when uveitis is controlled medically. Multistage surgery may be necessary to address each complication of uveitis using diverse strategies. Finally, a close relation should be fostered among pediatricians, pediatric rheumatologist, and ophthalmologist to more effectively diagnose and manage children with uveitis.
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U2 - 10.1097/IIO.0b013e31817d7fc1
DO - 10.1097/IIO.0b013e31817d7fc1
M3 - Review article
C2 - 18645407
AN - SCOPUS:51649083863
SN - 0020-8167
VL - 48
SP - 153
EP - 172
JO - International ophthalmology clinics
JF - International ophthalmology clinics
IS - 3
ER -