Blindness and ocular posterior segment involvement in the acute phase of Kawasaki disease: a mini-review

Abstract

: Ocular involvement in the acute phase of Kawasaki disease typically involves the anterior segment of the eye, and its associated treatment outcomes are generally excellent. However, there are rare reports of posterior segment involvement, and these are associated with poorer outcomes. This study reviewed six patients with recently reported blindness and/or ocular posterior segment involvement in the acute phase of Kawasaki disease. The median age of these patients was 8.5 years old (range: 6-12 years old). The ocular symptoms were photophobia, reduction of vision, blindness, and ocular pain. Five patients exhibited optic disc involvement and three patients showed retinal vessel involvement. All patients received intravenous immunoglobulin therapy and two patients received systemic corticosteroid administration. The visual acuity outcomes of treatment were excellent in five of the patients. However, in one patient there was still no light perception in the affected eye at two months after the initial onset of the disease. This was associated with the possible obstruction of the ophthalmic artery due to vasculitis. Older children may have a higher associated risk of blindness and ocular posterior segment involvement in the acute phase of Kawasaki disease.

Acute Phase Complications of Older Children with Kawasaki Disease

“…[19] Previous studies showed that the older children have a risk of non-cardiac complications including arthritis, ocular complications, and AARF during acute phase of KD. [2,3,20] Those findings were consistent with the present study in the patients who received initial IVIG therapy with DUA. Two patients were associated with arthritis in the present study.…”

“…Older children may have a higher risk of blindness and ocular posterior segment involvement in the acute phase of KD. [3] Ocular involvement in the acute phase of KD typically involves the anterior segment of the eye, and its associated treatment outcomes are generally excellent. However, there are rare reports of posterior segment involvement, and these are associated with poorer outcomes.…”

“…However, there are rare reports of posterior segment involvement, and these are associated with poorer outcomes. [3,23,24] The persistent inflammation caused by KD may lead to ocular posterior segment involvement. [24] The causes of transient blindness of the patient in the present study were thought to be compression of the optic disc via increased intraocular pressure due to uveitis and possible subclinical optic perineuritis.…”

“…[2,3] Older children with KD who received initial IVIG therapy with concomitant use of aspirin have a risk for acute phase complications including both CAL and non-cardiac complications. [2][3][4][5] At present, the standard therapy for the acute phase of this disease is intravenous immunoglobulin (IVIG) therapy at 2 g/kg/dose with the concomitant use of medium-or higherdose aspirin. [6] However, the concomitant use of medium-or higher-dose aspirin is now controversial.…”