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02.11.2018 | Clinical Investigation

Management of presumed trematode induced granulomatous uveitis in pediatric patients

Zeitschrift:
Japanese Journal of Ophthalmology
Autoren:
Rowayda Mohamed Amin, Alaa E. Radwan, Mohamed B. Goweida, Hesham F. El Goweini, Ahmed M. Bedda, Wael M. Lotfy, Ahmed R. H. Ahmed
Wichtige Hinweise
Corresponding author: Rowayda Mohamed Amin

Abstract

Purpose

To outline the management of newly identified trematode induced uveitis in pediatric patients

Study design

Prospective interventional case series

Methods

Patients with distinctive uveitis were recruited to either receive steroid monotherapy or undergo surgical excision of the inflammatory lesions based on a scoring system. Outcome measures included best corrected visual acuity (BCVA), intraocular inflammatory activity, and incidence of ophthalmic complications

Results

170 patients (174 eyes) were recruited. Mean age was 11.1 years. Mean initial decimal BCVA (± SD) was 0.58 (± 0.31). Of 116 eyes with disease scores <5, 109 were treated effectively with steroids (93.97%). Surgical excision was offered to 58 patients and proved curative in the treated eyes. Protracted inflammation with persistence of the granulomas was noted in 5 patients refusing surgery. Mean follow up period was 21.5 months. Mean final BCVA was 0.69 (±0.27). A significant change in BCVA was noted (p=0.002). There has not been a need for retreatment in any of the study patients, who were also given instructions on evading exposure to fresh water habitats. Larger lesions, mixed disease morphology, older age at presentation were associated with higher rates of ophthalmic complications and vision loss

Conclusion

A novel waterborne trematode inducing uveitis has been identified in Egypt. A favorable response to steroid monotherapy is demonstrated in low grade disease, while surgical excision was found to be curative in patients with larger lesions or those showing suboptimal response to medical treatment

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