Clinical and therapeutic characteristics of childhood uveitis in a tertiary center in Tunisia

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Published Sep 27, 2023
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Vol. 101 No. 5 (2023): Tunis med may 2023

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Salma Gargouri
Department of Ophtalmology, Habib Bourguiba University Hospital, Faculty of Medicine of Sfax, University of Sfax
Kmar Maaloul
Department of Ophtalmology, Habib Bourguiba University Hospital, Faculty of Medicine of Sfax, University of Sfax
https://orcid.org/0000-0001-9256-9197
Imene Kaibi
Department of Ophtalmology, Habib Bourguiba University Hospital, Faculty of Medicine of Sfax, University of Sfax
Mona Rekik
Department of Ophtalmology, Habib Bourguiba University Hospital, Faculty of Medicine of Sfax, University of Sfax
Hajer Aloulou
Department of Pediatrics, Habib Bourguiba University Hospital, Faculty of Medicine of Sfax, University of Sfax
Amira Trigui
Department of Ophtalmology, Habib Bourguiba University Hospital, Faculty of Medicine of Sfax, University of Sfax

Abstract

Introduction: Childhood uveitis is a rare condition with various associated diagnostic and therapeutic challenges.


Aim : We proposed to describe the distribution, clinical findings, treatment, complications, and visual outcomes of uveitis in children at a tertiary referral center in Sfax, Tunisia.


Methods: A retrospective study of 33 children (54 eyes) with uveitis collected over the period from January 2009 to December 2018 was carried out at the Ophthalmology Department of Habib Bourguiba University Hospital, Sfax, Tunisia. The data from the clinical examination, the etiological assessment, and the used treatments were collected. Standard diagnostic criteria were used for all uveitic syndromes or entities.


Results: The mean age of the patients was 11.42 years with a male-to-female ratio of 0.74. Uveitis was bilateral in 63% of the patients. The most common anatomical form was intermediate uveitis (39%). Idiopathic cases accounted for 52%. The major complications were posterior synechiae, optic disc edema, cataract, and cystoid macular edema. Anti-infective treatment was prescribed in 24% of the patients. Oral corticosteroid therapy was used in 67% of the patients. 18% of the patients received immunosuppressive therapy and 6% received a biological agent. The mean final visual acuity was 4.6/10.


Conclusion: Childhood uveitis is a serious pathology with frequent and vision-threatening complications. The etiologies are variable and the assessment can remain negative. A rigorous diagnostic approach, an oriented etiological assessment in collaboration with the pediatrician, and an appropriate therapy are necessary for management.

Keywords:

childhood uveitis, epidemiology, etiology, corticotherapy, immunosuppressive therapy, Tunisia, North Africa

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Tsirouki T, Dastiridou A, Symeonidis C, et al. A Focus on the Epidemiology of Uveitis. Ocul Immunol Inflamm 2018;26(1):2‑16.
  2. Gritz D. Incidence and prevalence of uveitis in Northern California The Northern California Epidemiology of Uveitis Study. Ophthalmology 2004;111(3):491‑500.
  3. Päivönsalo‐Hietanen T, Tuominen J, Saari KM. Uveitis in children: Population-based study in Finland. Acta Ophthalmol Scand. 2000;78(1):84‑8.
  4. Edelsten C, Reddy MA, Stanford MR, Graham EM. Visual loss associated with pediatric uveitis in english primary and referral centers. Am J Ophthalmol. 2003;135(5):676‑80.
  5. Khairallah M, Attia S, Zaouali S, et al. Pattern of Childhood-Onset Uveitis in a Referral Center in Tunisia, North Africa. Ocul Immunol Inflamm 2006;14(4):225‑31.
  6. Chebil A, Chaabani L, Kort F, Ben Youssef N, Turki F, EL Matri L. Étude épidémiologique des uvéites de l’enfant : à propos de 49 cas. J Fr Ophtalmol 2012;35(1):30‑4.
  7. Ferrara M, Eggenschwiler L, Stephenson A, et al. The Challenge of Pediatric Uveitis: Tertiary Referral Center Experience in the United States. Ocul Immunol Inflamm 2019;27(3):410‑7.
  8. Abd El Latif E, Fayez Goubran W, El Gemai EEDM, et al. Pattern of Childhood Uveitis in Egypt. Ocul Immunol Inflamm 2018;1‑7.
  9. Gautam N, Singh R, Agarwal A, et al. Pattern of Pediatric Uveitis at a Tertiary Referral Institute in North India. Ocul Immunol Inflamm 2018;26(3):379‑85.
  10. Ozdal PÇ, Sen E, Yazici A, Ozturk F. Patterns of childhood-onset uveitis in a referral center in Turkey. J Ophthalmic Inflamm Infect 2012;2(1):13‑9.
  11. Paroli MP, Spinucci G, Liverani M, Monte R, Pezzi PP. Uveitis in Childhood: An Italian Clinical and Epidemiological Study. Ocul Immunol Inflamm 2009;17(4):238‑42.
  12. Loukil I, Naija O, Wathek C, et al. Les uvéites de l’enfant. J Pédiatrie Puériculture 2012;25(4):193‑8.
  13. Smith JA, Mackensen F, Sen HN, et al. Epidemiology and Course of Disease in Childhood Uveitis. Ophthalmology 2009;116(8):1544-1551.e1.
  14. Rousseau A, de Monchy I, Labetoulle M. Chapitre3 - Épidémiologie des uvéites. In: Bodaghi B, LeHoang P. Uvéite (Deuxième Édition). Paris: Elsevier Masson; 2017. p. 23‑30.
  15. Cunningham ET. Uveitis in children. Ocul Immunol Inflamm 2000;8(4):251‑61.
  16. Holland GN, Stiehm ER. Special considerations in the evaluation and management of uveitis in children. Am J Ophthalmol 2003;135(6):867‑78.
  17. Kump LI, Cervantes-Castañeda RA, Androudi SN, Foster CS. Analysis of Pediatric Uveitis Cases at a Tertiary Referral Center. Ophthalmology 2005;112(7):1287‑92.
  18. Gupta A, Ramanan AV. Uveitis in Children: Diagnosis and Management. Indian J Pediatr 2016;83(1):71‑7.
  19. Biswas J, Majumder P. Pediatric uveitis: An update. Oman J Ophthalmol. 2013;6(3):140.
  20. Kim SJ. Diagnosis and Management of Noninfectious Pediatric Uveitis. Int Ophthalmol Clin. 2011;51(1):129‑45.
  21. Angioi-Duprez K. Chapitre58 - Conduite à tenir devant une uvéite pédiatrique. In: Bodaghi B, LeHoang P. Uvéite (Deuxième Édition). Paris: Elsevier Masson; 2017. p. 475‑9.
  22. Pivetti-Pezzi P. Uveitis in children. Eur J Ophthalmol 1996;6(3):293‑8.
  23. Tugal-Tutkun I. Pediatric uveitis. J Ophthalmic Vis Res 2011;6(4):259‑69.
  24. Edelsten C, Lee V, Bentley CR, Kanski JJ, Graham EM. An evaluation of baseline risk factors predicting severity in juvenile idiopathic arthritis associated uveitis and other chronic anterior uveitis in early childhood. Br J Ophthalmol 2002;86(1):51‑6.
  25. Weber M. Chapitre53 - Conduite à tenir devant une uvéite intermédiaire. In: Bodaghi B, LeHoang P. Uvéite (Deuxième Édition). Paris: Elsevier Masson; 2017. p. 437‑41.
  26. Wentworth BA, Freitas-Neto CA, Foster CS. Management of pediatric uveitis. F1000Prime Rep 2014;6(41).
  27. Choi J, Hawley DP, Ashworth J, Edelsten C, Bossuyt ASAM. An update on the modern management of pediatric uveitis. Br J Ophthalmol. 2019; 103(12):1685-9.