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      Total exudative retinal detachment in a child with pars planitis- a challenging case with optimistic results

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          Abstract

          We describe a case report of pediatric pars planitis complicated with massive exudative retinal detachment (ERD). A 7-year-old presented with visual acuity (VA) in the right eye (RE) of 6/9 and in the left eye (LE) 6/15. Fundoscopy revealed BE inferior retinoschisis, vitritis and snowballs. He was treated with systemic immunosuppressants. RE retinoschisis resolved within 2 months. Three years later presented with LE VA 6/60 and total ERD. Systemic and intravitreal steroids were administered. Due to refractoriness, he underwent 360° scleral buckle and drainage of subretinal fluid. No retinal breaks or traction were detected. Five months postoperatively LE VA was 6/7.5. Long-term stable outcome was maintained. We report a challenging total ERD as a complication of pars planitis. Although extensive and non-responsive to medical therapy, complete resolution and improvement in vision was achieved with surgical intervention and systemic immunosuppression. We speculate that uncontrolled chronic vasculitic process culminated in diffuse ERD.

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          Long-term visual outcome and complications associated with pars planitis.

          Susan M Malinowski, Jose S. Pulido, James C. Folk (1993)
          To identify the ocular complications and to statistically evaluate the possible association of pars planitis with multiple sclerosis (MS) in a homogeneous population of pars planitis patients. The authors reexamined 36 patients and reviewed the records of an additional 18 patients (total: 54 patients, 108 eyes) with idiopathic pars planitis. The initial mean visual acuity of 20/46 (logMAR: 0.36 +/- 0.50) was not statistically different from the final mean visual acuity of 20/44 (logMAR: 0.34 +/- 0.45; P = 0.73), after a mean follow-up of 89.2 months. Complications included neovascularization with or without associated vitreous hemorrhage (7 eyes, 6.5%), moderate to severe cellophane retinopathy (7 eyes, 6.5%), chronic cystoid macular edema (CME) (9 eyes, 8.3%), visually significant cataracts (16 eyes, 14.8%), and retinal detachment (9 eyes, 8.3%). Significant lens opacification was associated with a greater risk of retinal detachment (P = 0.004). In four patients (7.4%), optic neuritis developed, and in an additional eight patients (14.8%) MS developed. Kaplan-Meier analysis of these data showed a 16.2% +/- 6.2% risk of MS solely developing in patients, and a 20.4% +/- 6.7% risk of either MS or optic neuritis developing, after 5 years of disease. The presence of periphlebitis at the time of pars planitis diagnosis increased the rate of development of these conditions (P = 0.002). Six patients (11.1%) had a family history positive for MS in a first-degree relative. This study demonstrates the overall favorable visual prognosis in patients with pars planitis. Patients with significant cataract formation appear to be at greater risk for retinal detachment. Periphlebitis at the time of diagnosis of pars planitis increases the risk of development of optic neuritis or MS. The strong association demonstrated between pars planitis and MS in this study further supports a link between the two disease states.
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            Pars Planitis: Epidemiology, Clinical Characteristics, Management and Visual Prognosis

            Pinar Cakar Ozdal, Nilufer Berker, Ilknur Tugal-Tutkun (2015)
            Pars planitis is an idiopathic chronic intermediate uveitis which predominantly affects children and adolescents, and accounts for 5-26.7% of pediatric uveitis. Although an autoimmune process with a genetic predisposition has been suggested, its etiology still remains unknown. The most common presenting symptoms are floaters and blurred vision. Diffuse vitreous cells, haze, snowballs and snowbanks are typical findings of pars planitis. Peripheral retinal vasculitis, optic disc edema and anterior segment inflammation are other well-known findings. Although pars planitis is known to be a benign form of uveitis in most cases, it may become a potentially blinding disease due to complications including cataract, cystoid macular edema, vitreous opacities and optic disc edema. Cystoid macular edema is the most common cause of visual morbidity. Band keratopathy, epiretinal membrane formation, vitreous condensation, neovascularizations, vitreous hemorrhage, retinal detachment, cyclitic membranes, glaucoma and amblyopia may develop as a consequence of the chronic course of the disease. Exclusion of infectious and non-infectious causes which may present with intermediate uveitis is of utmost importance before starting treatment. Treatment of pars planitis has been a controversial issue. There is no consensus specifically for treatment of cases with minimal inflammation and relatively good visual acuity. However, current experience shows that pars planitis may cause severe inflammation and needs an aggressive treatment. A stepladder approach including corticosteroids, immunosupressive agents, anti-tumor necrosis factor-alpha and pars plana vitrectomy and/or laser photocoagulation is the most commonly used method for treatment of pars planitis. Adequate control of inflammation and prompt detection of associated complications are crucial in order to improve the overall prognosis of the disease.
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              Peripheral retinoschisis and exudative retinal detachment in pars planitis.

              Aryeh Pollack, H Richard McDonald, Robert Johnson … (2002)
              To review and describe bullous retinoschisis and exudative retinal detachment in patients with pars planitis.
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                Author and article information

                Contributors
                Ana Navarrete: ananav@hadassah.org.il
                Journal
                Journal ID (nlm-ta): J Ophthalmic Inflamm Infect
                Journal ID (iso-abbrev): J Ophthalmic Inflamm Infect
                Title: Journal of Ophthalmic Inflammation and Infection
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Electronic): 1869-5760
                Publication date (Electronic): 27 February 2023
                Publication date PMC-release: 27 February 2023
                Publication date Collection: 2023
                Volume: 13
                Electronic Location Identifier: 6
                Affiliations
                GRID grid.17788.31, ISNI 0000 0001 2221 2926, Department of Ophthalmology, , Hadassah Medical Center, ; Jerusalem, Israel
                Article
                Publisher ID: 328
                DOI: 10.1186/s12348-023-00328-3
                PMC ID: 9971364
                PubMed ID: 36849851
                SO-VID: ff3d4944-caf5-4c70-81d3-6b63e7df575a
                Copyright © © The Author(s) 2023
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 13 July 2022
                Date accepted : 21 January 2023
                Categories
                Subject: Brief Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2023

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: pars planitis,exudative retinal detachment,uveitis,buckle,immunosuppressants
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: pars planitis, exudative retinal detachment, uveitis, buckle, immunosuppressants

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