幼年特发性关节炎伴发葡萄膜炎

幼年特发性关节炎（JIA）是指发生在16岁以下儿童以慢性关节炎为主要临床表现的全身多系统自身免疫性疾病,临床表现为不明原因的持续6周以上的关节肿胀或炎症。大约有10%的患者伴有葡萄膜炎症,具有发病隐匿、炎症反应轻、并发症多和视力损害重等特点。好发人群为关节炎发病年龄小、抗核抗体阳性的女性少关节型关节炎患者。典型临床表现为双眼不对称的慢性轻度前葡萄膜炎,常见致盲性并发症有角膜带状变性、虹膜后粘连、并发性白内障和继发性青光眼等。局部应用糖皮质激素、非甾体抗炎剂和散瞳剂是主要治疗措施,顽固性患者需全身加用糖皮质激素、免疫抑制剂或生物制剂治疗,并发性白内障患者在围手术期需加强抗炎治疗。对幼年关节炎患儿进行密切眼部随访和及早诊治,可减轻葡萄膜炎病情和降低致盲性并发症的损害。     

顽固性葡萄膜炎并发性白内障的手术治疗

目的 探讨顽固性葡萄膜炎并发性白内障的手术方法和效果.方法 采用晶状体超声乳化后房型人工晶状体植入术治疗顽固性葡萄膜炎并发性白内障12例(16眼).术前单独使用皮质类固醇或需要联合使用免疫抑制剂对葡萄膜炎患者治疗.术后随访6～12月,平均8.5月.结果 手术后视力均有提高,术后最佳矫正视力<0.1者2眼(12.50%),0.1～0.4者3眼(18.75%),0.5～0.9者7眼(43.75%),≥1.0者4眼(25.00%).无严重并发症发生.结论 顽固性葡萄膜炎并发性白内障经过规范治疗进行白内障人工晶状体手术是安全有效的.     

幼年型慢性关节炎伴发葡萄膜炎一家系

1临床资料患者,女,15岁,因“双眼视力差且逐渐加重10a”于2005年11月28日到我院就诊。眼科检查:视力:右:手动/眼前,左:手动/眼前;右眼角膜中央带状变性,前房中央1CT,周边1/3CT,瞳孔膜闭,晶状体表面满布色素沉着,隐约可见晶状体混浊,余窥不清;左眼角膜2点、8点钟位带状角膜变性,前房中央1CT,周边1/3CT,瞳孔膜闭,晶状体表面满布色素沉着,隐约可见晶状体混浊,余窥不清。全身检查右手第5指关节变形。患者的外婆、母亲、姨妈、姨妈的女儿均有视力减退接近失明、指关节变形的病史。诊断:幼年型慢性关节炎伴发葡萄膜炎(少关节型)。2讨论幼年型…     

葡萄膜炎并发性白内障的手术治疗

葡萄膜炎并发性白内障的手术治疗效果与葡萄膜炎的类型、手术适应证的选择、手术时机、手术前后炎症的控制以及人工晶状体的类型等有密切关系。本就以上问题做一综述。     

儿童双眼葡萄膜炎并发白内障的处理

13岁女性,因“双眼视力下降4年,不伴红痛”人院。双眼矫正视力：右眼眼前手动,左眼0．1。裂隙灯检金：双眼角膜带状变性,KP（-）,虹膜后粘连,右眼晶状体混浊,表面色素附着,左眼晶状体表面色素纤维膜覆盖,双眼内窥不清。指测眼压：双眼T＋1。患儿曾诊断为葡萄膜炎、白内障。两年前左眼白内障摘除并植入人丁晶状体,期间末正规治疗葡萄膜炎,现为行右眼白内障手术入院。讨论体会：儿童女性患者双眼前葡萄膜炎应考虑幼年型类风湿关竹炎／幼年型特发性关节炎（JRA／JIA）的可能,早期控制原发病、合理治疗并发症是改善视力预后的关键。     

幼年特发性关节炎并发葡萄膜炎的治疗新进展

近年来,幼年特发性关节炎并发葡萄膜炎的治疗取得了一定的进展,但由于疾病的复发率较高,病情较复杂,使该病较难控制.现有药物的副作用较多,难以有效地控制疾病的发展,探索新的治疗方案是目前的研究热点.本文我们就目前已知的治疗方案以及未来可能应用于临床的治疗方法进行综述.     

阿达木单抗治疗难治性幼年特发性关节炎相关葡萄膜炎12个月效果观察

目的 研究阿达木单抗(ADA)治疗幼年特发性关节炎(JIA)相关葡萄膜炎的疗效及安全性。设计回顾性病例系列。研究对象2020年6月至2021年9月北京同仁医院使用ADA治疗的难治性JIA相关葡萄膜炎患者16例(28眼),其中前葡萄膜炎10例(18眼),全葡萄膜炎6例(10眼)。方法回顾分析患者的门诊病历资料。所有患者行ADA皮下注射治疗,体重≥30 kg者,初始剂量80 mg,以后每2周1次,每次40 mg;体重<30 kg者剂量减半。在炎症控制后,糖皮质激素和免疫抑制剂逐渐减量。主要指标前房炎性细胞、前房闪辉以及玻璃体浑浊,视力、糖皮质激素以及免疫抑制剂剂量变化,ADA副作用。结果ADA治疗后3～6个月内所有患眼葡萄膜炎均获得控制,前房炎性细胞、前房闪辉及玻璃体浑浊均由2+～3+降至0～1+;随访≥12个月未见复发。在ADA治疗炎症控制稳定后,8/10例前葡萄膜炎患者停用所有药物,2/10例患者停用免疫抑制剂;4/6例全葡萄膜炎患者停用口服糖皮质激素,只口服免疫抑制剂和使用ADA,2/6例患者糖皮质激素和免疫抑制剂均减量。ADA治疗后,视力提高≥2行者20/28眼,≥1行者8/...     

葡萄膜炎并发性白内障手术治疗研究进展

并发性白内障是葡萄膜炎最常见的并发症之一,可引起严重视力损害。由于葡萄膜炎患者常合并其他并发症,白内障手术操作复杂,术后视力不易维持。然而,手术医生如能严格掌握手术时机,选择合适的手术方式及人工晶状体,积极联合糖皮质激素及免疫抑制剂控制围手术期炎症,并且积极防治术后并发症,多可取得满意的视力预后。     

幼年型慢性关节炎伴发葡萄膜炎患者的临床特征和诊断及治疗

目的　探讨幼年型慢性关节炎(JCA)伴发葡萄膜炎的临床特征、诊断及治疗。方法对1996至2002年间于中山大学中山眼科中心葡萄膜炎专科就诊的26例JCA伴发葡萄膜炎患者采集病史,进行常规裂隙灯显微镜、检眼镜、抗核抗体(ANA)、红细胞沉降率(ESR)、类风湿因子(RF)、C反应蛋白(CRP)及抗链球菌溶血素“O”(ASO)等检查。根据临床需要,部分患者进行人类白细胞相关抗原B27(HLA B27)检测和骶髂关节及脊柱X线检查,并分析患者的治疗、预后及并发症等情况。结果　26例患者中男性11例,女性15例;JCA和葡萄膜炎的中位发病年龄分别为(8±7)岁和(9±5)岁;其中慢性前葡萄膜炎21例,急性前葡萄膜炎3例,慢性全葡萄膜炎2例; 22例患者双眼患病, 4例单眼患病,患眼共有48只;其中33只眼有轻至中度前房闪辉, 24只眼有少至中等量房水细胞, 39只眼发生虹膜后粘连; 30只眼并发白内障, 20只眼并发角膜带状变性, 12只眼继发青光眼。实验室检查发现18例患者呈ANA阳性,ASO均为阴性,RF仅1例为阳性。炎性反应急性期给予睫状肌麻痹剂、糖皮质激素滴眼治疗。病情较顽固的6例患者中, 3例加用环孢霉素A口服治疗, 3例加用苯丁酸氮芥口服治疗,炎性反应均良好控制。16只眼由于治疗前已合并严重的并发症,视力无显著提高;余32只眼视力均有不同程度提高。     

托珠单抗治疗幼年特发性关节炎相关葡萄膜炎的研究进展

葡萄膜炎是幼年特发性关节炎（JIA）最常见的关节外表现,多表现为反复发作的慢性前葡萄膜炎,其发病隐匿、并发症多等特点可导致患者眼部结构损伤、视力丧失。白细胞介素6（IL-6）是一种多效性细胞因子,参与炎症反应和免疫调节等过程,而托珠单抗是一种人源性IL-6受体（IL-6R）单克隆抗体,通过竞争性与IL-6R结合从而抑制...     

Pseudophakia in children with juvenile arthritis

Background: Cataract secondary to juvenile rheumatoid arthritis is a severe, vision-threatening complication in early childhood. Intraocular lens implantation is controversial. The follow-up of four pseudophakic eyes of three patients and their perioperative therapeutic regimen were retrospectively analyzed. Early and late postoperative complications are reported. Patients and methods: Both girls had lens aspiration and posterior lens implantation at the ages of 6 and 12 years, the boy at the age of 10 and 14 years. All patients had relapsing anterior uveitis. The follow-up time was 3 years (1–6 years). One girl was diagnosed with sarcoidosis, causing juvenile arthritis. Both girls had perioperative methothrexate and prednisolone therapy. The boy had azathioprine therapy at the time of his first cataract surgery; later he had no systemic therapy. Both girls' intraocular lenses were implanted at different eye hospitals. Results: Both girls had severe inflammatory reactions after surgery. At the hospitals both eyes had surgical revision for iris capture. In one case this was combined with exchanging the intraocular lens. Iris capture persisted for this eye and later vitrectomy with silicone oil filling was necessary to delay phthisis, resulting in amaurosis. For two pseudophakic eyes vitrectomy was necessary later because of severe vitreous opacities, but visual acuity was severely diminished by chronic cystoid macular edema and epiretinal membranes. The boy developed in his second eye intermittent iris bombata and persistent secondary glaucoma, visual acuity was stabilized at 0.5. Conclusions: Secondary cataract due to juvenile rheumatoid arthritis or sarcoidosis is a difficult situation for phacoemulsification with intraocular lens implantation in children. For severe inflammatory complications intense local and systemic anti-inflammatory therapy is mandatory. Visual prognosis is reduced for the uveitic posterior segment and glaucoma complications. IOL implantation can be recommended for only a very few patients.      

Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis

Purpose: Management of uveitic cataract in patients with juvenile idiopathic arthritis (JIA) is challenging, and intraocular lens (IOL) implantation is controversial. This study investigated the outcome after minimally invasive surgery with IOL implantation. Methods: Retrospective analysis after phacoemulsification with in‐the‐bag IOL implantation was performed in 16 patients (17 operations) with ANA‐positive JIA‐associated chronic uveitis. In these patients, 25 G capsulectomy and anterior vitrectomy was performed and they received an intravitreal triamcinolone (TA) injection. Results: Mean age at uveitis onset was 5 ± 2 years, and surgery was performed at a mean age of 11 ± 2.2 years. Preoperatively, uveitis was inactive in all patients, and visual acuity was logMAR 0.8 ± 0.44; additional uveitis complications were present in all patients, and 15 patients were receiving systemic immunosuppression/biologicals. After surgery (mean follow‐up 26.5 ± 11.7 months), presence of cystoid macular oedema, papilloedema, ocular hypertension/glaucoma and hypotony did not increase compared with baseline. There was no significant worsening of AC inflammation (by cell numbers and laser flare values). IOL deposits persisted in four patients, and synechiae developed in eight. The visual acuity was improved (≥2 lines) in all patients (mean logMAR 0.3 ± 0.24). Retrolental membrane formation was not noted. Secondary capsular opacification was observed in seven patients, requiring Nd:YAG capsulotomy in five of them. Conclusions: Phacoemulsification and in‐the‐bag IOL implantation may improve visual outcome in JIA‐associated uveitis with minimally invasive surgical technique and intravitreal TA injection. Well‐controlled uveitis with appropriate use of topical steroids and systemic immunosuppression or biologicals appears as a perioperative requirement.     

葡萄膜炎并发白内障术后临床对比观察

目的：观察葡萄膜炎并发白内障施行人工晶状体植入术的安全性。方法：采用双盲法，对15例20眼施术，其中前葡萄膜炎12例，全葡萄膜炎3例。在施行白内镜摘出术时，随机分成植入人工晶状体组或不植入人工晶状体组。结果：术后2年观察，两组矫正视力统计学上的差异无显著性意义。但是，葡萄膜炎并发性白内镜患者行单纯白内障摘出而不植入人工晶状体，倾向于获得较好的视力。结论：对葡萄膜炎者施行白内障摘出人工晶状体植入术是相对安全的。不植入人工晶状体是否确定能获得较好的视力，尚需进行大量的临床研究。     

Recent advances in uveitis of juvenile idiopathic arthritis

Chronic scarring-type uveitis is a frequent extra-articular manifestation of juvenile idiopathic arthritis. It occurs in about 20% of children with this disease, commencing typically within a few years from its onset. The risk of uveitis is greatest in antinuclear antibody-positive girls with early onset oligoarthritis. The classic clinical picture is chronic bilateral anterior uveitis, usually asymptomatic until substantial damage to intraocular structures occurs. In view of the asymptomatic nature of the condition, routine screening of juvenile idiopathic arthritis patients 2-4 times a year is crucial to prevent complications. The treatment consists of topical corticosteroids and mydriatics, in severe cases with immunosuppressive agents, and surgical management of complications. Although the prognosis of uveitis is improving, there are cases refractory to standard regimens. Patients in whom uveitis commences prior to the onset of arthritis present a special problem.     

Pathogenesis of juvenile idiopathic arthritis associated uveitis: the known and unknown

Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease and the most prevalent systemic disorder in children with uveitis. The current prevailing opinion is that JIA is a multifactorial, genetically predisposed autoimmune disorder that can be influenced by environmental factors and infections; the specific pathogenesis of JIA-associated uveitis is not understood, however, nor has the relationship between the eye and joint inflammation been established. Nevertheless, subtypes of JIA that are associated with uveitis, oligoarthritis, polyarticular rheumatoid factor negative, and psoriatic arthritis appear to have common pathogenicity. We summarize our current knowledge regarding the pathogenesis of JIA-associated uveitis and discuss the possible role of immune responses and cytokine involvement, genetic associations, and the influence of external triggers in this disease—an association that is supported by data obtained from arthritis research and experimental uveitis models.     

Cataract surgery in patients with history of uveitis

Cataract surgery in patients with uveitis is not as simple as any senile cataract surgery. Recent evidence suggests that useful visual outcome can be achieved in most of the cases if they are handled meticulously. Key factors leading to improved visual outcome are absolute control of preoperative inflammation with diligent use of immunomodulatory drugs, meticulous surgery along with early detection and care of postoperative complications. Modern technologies in the intraocular lens designs and materials have contributed to the success. In this article, we review the literature on this subject with emphasis on the importance of the use of immunomodulatory drugs to control preoperative and postoperative intraocular inflammation and avoid complications.     

Incidence and outcomes of uveitis in juvenile rheumatoid arthritis, a synthesis of the literature

Background Juvenile rheumatoid arthritis (JRA) is the most common systemic cause of pediatric uveitis in Europe and North America. Uveitis is commonly perceived as a frequent sequela of JRA and JRA-associated uveitis is commonly considered to have a complicated course with frequent adverse visual outcomes. Methods We performed a systematic literature search for series of consecutive patients with JRA (as defined by the American College of Rheumatology criteria) reporting on the frequency of uveitis and/or complications of uveitis, published between January 1980 and December 2004. The main outcome measures were: the cumulative incidence of uveitis in JRA, the cumulative incidence of adverse visual outcome and that of complications in JRA-associated uveitis. Additionally, the influence of gender, presence of antinuclear antibody (ANA) and disease onset subtype to the likelihood of developing uveitis were examined. Results Analysis of pooled data from the 26 eligible series suggested a cumulative incidence of uveitis in JRA of 8.3% [95% confidence intervals (CI), 7.5–9.1%]. The cumulative incidence of uveitis varied according to geographic location, being highest in Scandinavia, then the US, then Asia and lowest in India. JRA-associated uveitis was more common in pauciarticular than polyarticular onset patients [odds ratio (OR)=3.2, 95% CI, 2.33–4.36] and in ANA-positive than ANA-negative patients (OR=3.18, 95% CI, 2.22–4.54). Female gender was only a weak risk factor for the development of uveitis in JRA patients (OR=1.69, 95% CI 1.09–2.62) and was not statistically significant after considering disease onset subtypes. In JRA-associated uveitis the cumulative incidence of cumulative incidence of adverse outcome (visual acuity <20/40 OU) was 9.2% (95% CI: 4.7–15.8) of cataracts 20.5% (95% CI: 15.5–26.3), of glaucoma 18.9% (95% CI: 14.4–24.2) and of band keratopathy 15.7% (95% CI: 10.9–21.7). Conclusion The cumulative incidence of uveitis in JRA varies according to geographic location, presence of ANA, type of JRA onset and gender. Uveitis, adverse visual outcome, and complications in JRA are less frequent than commonly accepted. Presented in part at the November 2003 American Academy of Ophthalmology meeting, Anaheim, Calif., USA (PO062). Supported by a research grant from the Department of Ophthalmology, Mayo Clinic, Rochester, MN and an unrestricted grant from Research to Prevent Blindness, Inc. New York, New York.     

葡萄膜炎并发白内障超声乳化人工晶状体植入

目的：评价超声乳化人工晶状体植入术对葡萄膜炎并发白内障的效果。方法：对28例32眼葡萄膜炎并发白内障施行了超声乳化吸出和后房人工晶状体植入术，对术后视力和并发症作了分析。结果：超声乳化人工晶状植入术后31眼视力提高，术后最常见的并发症为后囊浑浊。结论：超声乳化人工晶状植入术对于葡萄膜炎并发白内障是一种安全可靠的手术。