Objective To analyze the onset, clinical manifestation, causation, complications of pediatric uveitis. Methods One hundred and two patients with uveitis under 16 year-old were retrospectively studied. They visited the clinic in Peking University First Hospital from November 1979 to December 2008. Their age ranged from 2.5 to 16 years old, with a mean of 11.9 years. Routine exam was carried out, including visual acuity, slit lamp, fundus, and laboratory workup. The diagnosis and classification were made by the anatomic location according to the standard of The International Uveitis Working Group. The data of disease history, age of onset, manifestation, recurrence, causation, systemic diseases, complications, and lab examination were analyzed.Results A total of 102 patients (170 eyes) with pediatric uveitis were included in this study, 68 patients (66.6%) were bilateral cases. Anterior uveitis represented in 38 patients (37.3%), intermediate uveitis in 19 (18.6%), posterior uveitis in 10 (9.8%), and panuveitis in 35 (34.3%). The disease duration was from five days to 2.4 years, with a mean of 3.6 months. The follow-up time was two weeks to more than ten years. The first three causes of pediatric uveitis were juvenile idiopathic arthritis, Vogt-Koyanagi-Harada disease, and Behccedil;etprime;s disease. 36 patients were found with complications, and among them 19 had complicated cataract, seven had secondary glaucoma, five had corneal band dystrophy, 12 had iris synechia (both anterior and posterior), one had retinal detachment, two had eye atrophy, and one patient with juvenile idiopathic arthritis had bilateral femoral head necrosis because of the use of steroid and hip joint was replaced. There were ten children suffering more than two complications. Conclusions Pediatric uveitis is a possible blindness disease with variety of etiology and manifestations,and tends to cause complications. Early and special attention must be taken to avoid serious consequences.
Acquired syphilis uveitis, due to lack of the characteristic features, presents with various types. The most common type is posterior uveitis and panuveitis, including chorioretinitis, retinal vasculitis, optic nerve retinitis. The diagnosis and assessment of response to treatment depends mainly on the serological diagnostic tests, including nontreponemal and treponemal test. Acquired syphilis uveitis often presents with manifestations similar to various types of uveitis, especially to autoimmune uveitis and other infectious uveitis, so differential diagnosis is important. The gold standard treatment for active syphilitic uveitis is penicillin G, or doxycycline if patient is allergy to penicillin. Clinically misdiagnosis and delayed treatment may result in irreversible visual impairment and severe systemic and eye complications. However such timely treatment always has a good prognosis.
The etiology of uveitis is complex and the clinical manifestations are varied. Diagnosis and treatment are often very difficult. Detailed medical history, thorough ocular examination and laboratory examination are important basis for diagnosis. In recent years, with the appearance of microincision vitrectomy surgery, it has been applied widely in the diagnosis and treatment of uveitis. It can confirm diagnosis, manage the fundus complications of uveitis, and has certain therapeutic effects. But it is worth emphasizing that the indications of vitrectomy must be strictly controlled. Suitable indications and surgical timing are the key to the effective diagnosis and treatment of uveitis.
The knowledge of uveitis of Chinese eye doctors has been improved in general. While the usage of glucocorticoid agents was more reasonable, other non-corticoid immunosuppressant get more attention recently. The usage of antibiotics also has being reduced gradually. The international impact of our uveitis research has been enhanced. However there are still some problems, such as big difference between different regions of uveitis research, still many misunderstandings on the treatment of uveitis complications, and the reasonable evaluation of intravitreal injection with glucocorticoid needs emphasis. In China Behcetprime;s disease and Vogt-Koyangi-Harada syndrome are the most common uveitis subtypes which can lead to blindness,but some rare subtypes of uveitis are also increasing such as syphilitic uveitis, acquired immune deficiency syndrome（AIDS），mycotic endophthalmitis and masquerade syndrome. In the future we need cooperative studies between multicenters to investigate the effectiveness of different treatment strategies for Behcetprime;s disease and Vogt-Koyangi-Harada syndrome, and to optimizing the best therapeutic schedule. We also need to pay more attentions to the clinical features of those uveitis subtypes which increased recently；and to investigate the prevention and therapeutic effect of induction of immune tolerance to uveitis.