Abstract
BackgroundSurgeries for idiopathic uveitis and juvenile idiopathic arthritis-associated uveitis in children are complex because of the high risk of inflammatory postoperative complications. There is no consensus about treatment adaptation during the perioperative period. The objectives of this study are to report the therapeutic changes made in France and to determine whether maintaining or stopping immunosuppressive therapies is associated with an increased risk of surgical site infection or an increased risk of uveitis or arthritis flare-up.MethodsWe conducted a retrospective cohort study between January 1, 2006 and December 31, 2018 in six large University Hospitals in France. Inclusion criteria were chronic idiopathic uveitis or chronic uveitis associated with juvenile idiopathic arthritis under immunosuppressive therapies at the time of the surgical procedure, operated before the age of 16. Data on perioperative treatments, inflammatory relapses and post-operative infections were collected.ResultsA total of 76 surgeries (42% cataract surgeries, 30% glaucoma surgeries and 16% posterior capsule opacification surgeries) were performed on 37 children. Adaptation protocols were different in the six hospitals. Immunosuppressive therapies were discontinued in five cases (7%) before surgery. All the children in the discontinuation group had an inflammatory relapse within 3 months after surgery compared to only 25% in the other group. There were no postoperative infections.ConclusionsThe results of this study show varying practices between centres. The benefit-risk balance seems to favour maintaining immunosuppressive therapies during surgery. Further studies are needed to determine the optimal perioperative treatments required to limit post-operative inflammatory relapses.
Highlights
Surgeries for idiopathic uveitis and juvenile idiopathic arthritis-associated uveitis in children are complex because of the high risk of inflammatory postoperative complications
Idiopathic uveitis and juvenile idiopathic arthritisassociated uveitis are the first cause of uveitis in children [1,2,3]
Juvenile idiopathic arthritis (JIA) is associated with chronic uveitis in 10–40% of cases, especially in oligoarticular forms, in young girls with positive antinuclear antibodies (ANA) [4]
Summary
Surgeries for idiopathic uveitis and juvenile idiopathic arthritis-associated uveitis in children are complex because of the high risk of inflammatory postoperative complications. The objectives of this study are to report the therapeutic changes made in France and to determine whether maintaining or stopping immunosuppressive therapies is associated with an increased risk of surgical site infection or an increased risk of uveitis or arthritis flare-up. Cataract and intraocular hypertension unresponsive to medical treatment frequently requires surgical management to prevent amblyopia and other sequelae These surgeries are complex because of the high risk of postoperative complications because of underlying inflammation. The primary objective of this study is to describe the therapeutic adaptations used for ocular surgery of idiopathic uveitis and uveitis associated with JIA in children treated with immunosuppressive drugs in several French University Hospitals. The secondary objective is to determine whether maintaining or discontinuing immunosuppressive therapies is associated with an increase risk of surgical site infection or an increased risk of inflammatory relapse
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