Janet L. Alexander

Pediatric uveitis: new and future treatments.

Purpose of review Pediatric uveitis is relatively uncommon, accounting for only 5–10% of all patients with uveitis. However, owing to high prevalence of complications and devastating outcomes, its lifetime burden can be significant. Recent findings Immunomodulatory therapy has been associated with better outcomes in noninfectious pediatric uveitis. However, effective treatments are limited by medication-related complications, including multiorgan toxicities and systemic side effects. Summary We review the current therapies available to treat pediatric uveitis, discuss novel and future therapies, and provide clinical recommendations utilizing these new agents. The consideration for treatment regimens in noninfectious pediatric uveitis is multifactorial. Understanding past, present, and future technology will aid in treatment of a complex and refractory disease.

A case of frosted branch angiitis in an immunocompromised child.

Frosted branch angiitis is a rare vascular reaction believed to be a nonspecific immune response to an infective, neoplastic, or idiopathic insult. The clinical presentation is characteristic and typically affects children and younger adults, and the prognosis is good. We report a case of frosted branch angiitis during immune recovery in a 2-year-old boy with Langerhans cell histiocytosis on systemic immunosuppressive therapy.

Tubulointerstitial nephritis and uveitis (TINU) with granulomatosis: a novel report of simultaneous TINU and sarcoidosis in a pediatric patient

We report the case of a 7-year-old girl who presented with bilateral anterior uveitis, acute interstitial nephritis, and asymptomatic pulmonary granulomas and provide novel clinical evidence of an association between tubulointerstitial nephritis and uveitis syndrome and sarcoidosis.

Anterior segment ultrasound biomicroscopy image analysis using ImageJ software: Intra-observer repeatability and inter-observer agreement

PurposeIn this novel study, we demonstrate a standardized imaging and measurement protocol of anterior segment (AS) structures with reliability analysis using ultrasound biomicroscopy (UBM) and ImageJ software.MethodsTen pediatric and young adult patients undergoing examination under anesthesia for AS pathology were imaged using UBM. Four trained observers analyzed 20 images using ImageJ. Forty-five structural parameters were measured. Those that relied on the trabecular-iris angle (TIA) as a reference landmark were labeled TIA-dependent (TD) and all others were labeled non-TIA dependent (NTD). Intra-observer repeatability (IOR) and inter-observer agreement (IOA) of measurements were determined using coefficient of variation (CV) and intra-class correlation (ICC) followed by assessment of Bland–Altman plots (BAP) for each pair of observers, respectively.ResultsFor NTD parameters, non-ciliary body (CB) related measurements showed CV range 0.60–16.22% and ICC range 0.84–0.89, whereas CB-related parameters showed CV range 2.86–23.40% and ICC range 0.29–0.92. For TD parameters, parameters < 2 degrees removed from reference showed CV range 0.02–5.40% and ICC range 0.89–1.00, whereas parameters > 1 degree removed showed CV range 0.63–27.44% and ICC range 0.22–1.00. No systematic proportional bias was detected by BAPs.ConclusionsPreplaced landmarks yielded good IOR and IOA in quantitative assessment of AS structures that were NTD and non-CB-related or less removed from the reference. CB-related NTD measurements varied greatly in IOR and IOA, indicating protocol modifications or CB qualitative assessments needed to improve accuracy. Variability in TD measurements increased the further removed from the reference, which supports implementation of a reliable reference landmark to minimize variation.

Persistent Corneal Edema Associated With Subconjunctival 5-fluorouracil in an Infant With Primary Congenital Glaucoma

A 3-month-old boy with primary congenital glaucoma developed a transient corneal endothelial opacity after needle bleb revision with adjunctive 5-fluorouracil. This case presents a rare toxicity that, although transient, is concerning due to the potential of amblyopia. The authors review prior cases of corneal opacity associated with 5-fluorouracil. [J Pediatr Ophthalmol Strabismus. 2016;53:e54-e57.].

Pupillary block due to reverse implantation of a sulcus intraocular lens

An 88-year-old woman with a history of complicated cataract extraction by phacoemulsification with sulcus intraocular lens (IOL) placement developed pseudophakic pupillary block after reverse implantation of the IOL. In the postoperative period, she had persistently elevated intraocular pressures (IOP) and was diagnosed with chronic angle-closure glaucoma that was treated medically. She presented 5 years later with acute pupillary block. The diagnosis of reverse IOL implantation was confirmed by ultrasound biomicroscopy. An IOL repositioning, anterior synechialysis, and Baerveldt tube shunt placement led to resolution of the pupillary block and a well-controlled IOP.