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Time to steroid-free remission of uveitis in pediatric population
Volume 21 Number 4 / August 2017 113 Time to steroid-free remission of uveitis in pediatric population. Ujwala S. Saboo, Ashley Abraham, Cristiana Ronconi, Bruna L. Ducca, Araceli T. Lawand, Jennifer H. Cao Introduction: Chronic uveitis in children can lead to vision threatening complications due to the disease itself and chronic corticosteroid treatment. The purpose of the study was to evaluate the outcomes and time to achieve steroid-free remission with immunomodulatory therapy (IMT) in pediatric patients with uveitis. Methods: Retrospective review of 59 patients presented to uveitis clinic from September 2015 to May 2016 was performed. Patients diagnosed with recurrent uveitis, were steroid dependent, and treated with IMT were included. Results: A total of 37 patients (19 male) were included. The mean age was 10 4 years. Uveitis presentation comprised of anterior uveitis (9 patients), pars planitis (7), posterior uveitis (4) and panuveitis (17). Systemic diagnosis included juvenile idiopathic arthritis (7 patients), sarcoidosis (2) and Vogt Koyanagi Harada syndrome (1). Steroid-free remission (no disease activity in the absence of corticosteroid treatment at all subsequent visits for a minimum of 90 days) was achieved in 24.3% of patients within a mean duration of 113 63 days after starting IMT. The percentage of patients achieving steroid-free remission in recalcitrant uveitis (26%) was similar to those with new onset uveitis (23%). The side effects to IMT were nausea and vomiting (11%), hair loss (3%), rash (7%), anaphylaxis (5%), and drug induced lupus (3%). Discussion: Prompt and aggressive treatment with immunomodulatory therapy to attain steroid-free remission is achievable and critical in avoiding long-term complications from chronic steroid use. Conclusions: One fourth of the patients with chronic recurrent uveitis were able to achieve steroid-free remission on immunomodulatory therapy within a mean duration of 4 months after starting treatment. 114 Punctal occlusion for treatment of disabling photophobia in pediatric patients. Richard M. Schroeder, Gregg T. Lueder Introduction: Evaluation and treatment of photophobia is challenging in pediatric patients because their young age and discomfort may markedly limit their ability to cooperate with examination of the cornea and tear film. We describe the outcomes of patients with disabling photophobia managed with punctal occlusion. Methods: Case series of children with photophobia that severely limited their activities. The presenting signs and symptoms, procedures and evaluations performed, physical examination after interventions, and subjective outcomes were reviewed. The patients were unable to tolerate slit-lamp examination in the office. They were initially treated with a collagen plug trial, with subsequent permanent punctal occlusion with silicone plugs or cautery. Results: Three patients with disabling photophobia were treated. The first was a 3-year-old girl with no medical or other ocular problems. The second was a 10-month-old with IPEX syndrome. The third was a three-year-old with autistic behavior. All 3 patients had resolution of photophobia and resumption of normal activity shortly after punctal occlusion. Discussion: Severe photophobia is an uncommon problem in children that can be difficult to evaluate and treat. Improvement following punctal occlusion indicates that corneal dryness is the likely cause of the photophobia. Permanent occlusion may provide long-lasting relief to some patients with this problem.
Journal of AAPOS
e35 Conclusions: Punctal occlusion may be useful in the evaluation and management of pediatric patients with marked photophobia. 115 Congenital anterior polar cataract: surgical outcomes and associated corneal astigmatism. Emily Shortridge, Rupal Trivedi, Maria C. Artigas, Edward Wilson Introduction: Congenital anterior polar cataracts are rare (3% of congenital cataracts) and often do not cause visual compromise. Some cases demonstrate spread of opacity into the subcapsular cortex during childhood, causing decreased visual acuity and amblyopia. A high incidence of corneal astigmatism and strabismus in this population has been reported as additional causes of visual morbidity. Methods: A single-center, single-surgeon retrospective case review. We reviewed all cases undergone cataract extraction for visually significant anterior polar cataract 1/1995 to 9/2016. Results: Sixteen eyes of 13 patients required cataract extraction. Median patient follow-up was 6.3 years, with a range of 3 months to 12.5 years. Median age at surgery was 3 years, with a range of 4 months to 8.5 years. Median final visual acuity was 20/25. Twelve patients (92%) required postoperative patching for amblyopia. Four eyes (25%) required reoperation for postoperative visual axis opacificiation (VAO) (fibrous and/or cortical). A total of 5 eyes were microphthalmic, 3 of which underwent reoperation for VAO. Two eyes of 1 patient were microphthalmic and developed open angle glaucoma 2 years after surgery. The patient maintains healthy nerves and intraocular pressure on topical therapy. Median corneal astigmatism in operated eyes was 1.7 D by keratometry. Discussion/Conclusions: Anterior polar cataracts are not often visually significant at birth but may require surgery secondary to a spreading opacity in the underlying anterior subcapsular cortex. This can occur any time in the first decade of life. Amblyopia and corneal astigmatism are also common in these eyes. Management guidelines will be shared. 116 Kaneka stents for the treatment of nasolacrimal duct obstruction. David I. Silbert Introduction: The Kaneka Lacriflow Stent is a newly introduced self-retaining bi-canalicular intubation set, which can be placed without retrieval from the nose. The simplified insertion process decreases intraoperative time and intranasal trauma. The stent is not tied in the nose and can be removed easily in the office. We review a cohort of children to evaluate the success rate of stent placement for NLDO. Methods: Stents were placed in an outpatient surgery center under general anesthesia in pediatric patients. The stent is placed with a stylet through both punctum and self-retains due to a widened portion sitting distal to the common canaliculis in the lacrimal duct and sac. It does not require recovery from or removal from the nose. Results: Children were between the ages of 1-12 years. Stents were left in place for 3 months. Stents were placed successfully in 11 of 14 eyes. Two eyes of 2 different patients were not able to have the stent placed. There was an improvement in symptoms in all 8 eyes of 7 patients who we have follow up data on. Discussion: Kaneka Lacriflow stents can be removed easily in the office without entering the nose making them ideal for use in children. A new insertion technique, bending the stylet should allow it to be used in even the youngest children.
Journal of AAPOS
e35 Conclusions: Punctal occlusion may be useful in the evaluation and management of pediatric patients with marked photophobia. 115 Congenital anterior polar cataract: surgical outcomes and associated corneal astigmatism. Emily Shortridge, Rupal Trivedi, Maria C. Artigas, Edward Wilson Introduction: Congenital anterior polar cataracts are rare (3% of congenital cataracts) and often do not cause visual compromise. Some cases demonstrate spread of opacity into the subcapsular cortex during childhood, causing decreased visual acuity and amblyopia. A high incidence of corneal astigmatism and strabismus in this population has been reported as additional causes of visual morbidity. Methods: A single-center, single-surgeon retrospective case review. We reviewed all cases undergone cataract extraction for visually significant anterior polar cataract 1/1995 to 9/2016. Results: Sixteen eyes of 13 patients required cataract extraction. Median patient follow-up was 6.3 years, with a range of 3 months to 12.5 years. Median age at surgery was 3 years, with a range of 4 months to 8.5 years. Median final visual acuity was 20/25. Twelve patients (92%) required postoperative patching for amblyopia. Four eyes (25%) required reoperation for postoperative visual axis opacificiation (VAO) (fibrous and/or cortical). A total of 5 eyes were microphthalmic, 3 of which underwent reoperation for VAO. Two eyes of 1 patient were microphthalmic and developed open angle glaucoma 2 years after surgery. The patient maintains healthy nerves and intraocular pressure on topical therapy. Median corneal astigmatism in operated eyes was 1.7 D by keratometry. Discussion/Conclusions: Anterior polar cataracts are not often visually significant at birth but may require surgery secondary to a spreading opacity in the underlying anterior subcapsular cortex. This can occur any time in the first decade of life. Amblyopia and corneal astigmatism are also common in these eyes. Management guidelines will be shared. 116 Kaneka stents for the treatment of nasolacrimal duct obstruction. David I. Silbert Introduction: The Kaneka Lacriflow Stent is a newly introduced self-retaining bi-canalicular intubation set, which can be placed without retrieval from the nose. The simplified insertion process decreases intraoperative time and intranasal trauma. The stent is not tied in the nose and can be removed easily in the office. We review a cohort of children to evaluate the success rate of stent placement for NLDO. Methods: Stents were placed in an outpatient surgery center under general anesthesia in pediatric patients. The stent is placed with a stylet through both punctum and self-retains due to a widened portion sitting distal to the common canaliculis in the lacrimal duct and sac. It does not require recovery from or removal from the nose. Results: Children were between the ages of 1-12 years. Stents were left in place for 3 months. Stents were placed successfully in 11 of 14 eyes. Two eyes of 2 different patients were not able to have the stent placed. There was an improvement in symptoms in all 8 eyes of 7 patients who we have follow up data on. Discussion: Kaneka Lacriflow stents can be removed easily in the office without entering the nose making them ideal for use in children. A new insertion technique, bending the stylet should allow it to be used in even the youngest children.