Chirurgie de la cataracte uvéitique non infectieuse de l’enfant : bilan des pratiques actuelles en France

Abstract : Purpose: to evaluate the management of cataract surgery in children with chronic uveitis in various French pediatric ophthalmology centers. Materials and methods: Two-part study: - a first descriptive observational part on the evaluation of French practices. A questionnaire was sent to the various pediatric ophthalmologists in France. - A second retrospective chart review, including children with non-infectious chronic uveitis who had cataract surgery at the pediatric ophthalmology department of Bordeaux University Hospital from 2008 to 2017. Results: 21 ophthalmologists answered the questionnaire. Only 23.8% initiated systemic immunosuppressive drugs (excluding corticosteroid) before surgery. 88.2% prescribed oral corticosteroid treatment preoperatively. 11 surgeons performed intravenous corticosteroid pulses during the surgery and primary lens implantation is the most common method used in 95.2%. 76.2% initiated oral steroid therapy after surgery. Postoperatively, all surgeons started local therapy with high-dose corticosteroid. At one year, 100% achieved improvement of visual acuity greater than or equal of 2 lines. Regarding our service, 10 eyes (7 children) underwent cataract surgery. 7 were treated with systemic immunosuppressive drugs (excluding corticosteroid) and 80% of cases received oral corticosteroid therapy a few days before surgery. An intravenous corticosteroid pulse was administered preoperatively in 8 cases, and primary implantation was performed in 100% of cases. Postoperatively, 5 children had oral corticosteroid treatment. All was treated with local high dose of cortisone. At one year, the mean of the best-corrected visual acuity was 0.18 LogMar (0-0.7, SD: 0.25). Conclusion: cataract surgery leads to a good visual outcome in selected children with chronic uveitis. Optimal management require a strong anti-inflammatory protocol.
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Master Thesis
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Camille Costet. Chirurgie de la cataracte uvéitique non infectieuse de l’enfant : bilan des pratiques actuelles en France. Médecine humaine et pathologie. 2018. ⟨dumas-02066822⟩

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