Management of presumed trematode induced granulomatous uveitis in pediatric patients

Amin, Rowayda M.; Radwan, Alaa; Goweida, Mohamed Bahgat; Goweini, Hesham Fouad El; Bedda, Ahmed M.; Lotfy, Wael M.; Ahmed, Ahmed R.

doi:10.1007/s10384-018-0632-3

Cited by 8 publications

(17 citation statements)

References 30 publications

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“…Lesions were almost always recognized in young boys, as girls in these localities are not allowed to bathe or play in canal waters due to the conservative nature of the countryside. Similarly, other studies in both India and Egypt have reported that the majority of patients with anterior chamber granuloma were males and all were reporting bathing in local canal waters (Rathinam et al 2002;Arya et al 2016;Amin et al 2017;Amin et al 2019).…”

Section: Discussionmentioning

confidence: 56%

“…Amin and associates managed their patients according to a severity scoring system. A total of 116 eyes were identified as having lowgrade disease (score < 5) and were started on oral and topical steroid therapy, while those with severity scores ≥ 5 (58 eyes) at presentation were advised for surgical excision of the anterior chamber granulomas (Amin et al 2019). Surgical treatment appears to be curative and similarly medical treatment showed favourable response in those with scores <5.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment appears to be curative and similarly medical treatment showed favourable response in those with scores <5. (Amin et al 2019) In aforementioned studies, the authors used topical AE systemic steroids (1 mg/kg) as a medical treatment. In our patients, we have not used systemic steroids at all due to known side-effects in this vulnerable age group.…”

Section: Discussionmentioning

confidence: 99%

“…Several attempts have been made to identify the aetiology of such lesions. A molecular evidence of digenetic trematode has been reported as a cause of such peculiar inflammation in recent studies (Rathinam et al 2012;Arya et al 2016;Amin et al 2017;Amin et al 2019).…”

Section: Introductionmentioning

confidence: 97%

“…Such patients were treated with topical or systemic corticosteroids or both with variable success rates (Rathinam et al 2002). Surgical excision of large granulomas has been tried with favourable response (Rathinam et al 2002;Amin et al 2019).…”

Section: Introductionmentioning

confidence: 99%

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Anterior chamber granuloma: conservative treatment versus surgical intervention

Sadek

Ahmed

Kamal

et al. 2020

Acta Ophthalmologica

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Purpose A distinct pattern of granulomatous anterior uveitis, with white anterior chamber (AC) granuloma, has been reported in certain endemic areas. The aim of this work was to compare the outcome of conservative treatment to surgical intervention for the treatment of large AC granulomas presenting with moderate–severe anterior uveitis. The secondary outcome is ultrasound biomicroscopy (UBM) characterization of AC granulomas. Methods This is a prospective randomized interventional study including 41 eyes of 39 patients with active AC granuloma ≥3 mm (flare & cells ≥ +2). Patients were randomly assigned to either conservative treatment in the form of topical prednisolone and cycloplegic drops with orbital floor (transseptal) injection of Triamcinolone acetonide (20 eyes) or surgery in the form of granuloma excision and AC wash (21 eyes). As a perioperative care, topical steroids and cycloplegic drops were given few days before surgery and tapered gradually over 6 weeks. Patients were followed up at first day, 2 weeks, 1 and 3 months. Results Thirty‐seven patients were males, and 2 were females (13.0 ± 3.5 years). After 2 weeks, disappearance/healing of granuloma was achieved in 20 eyes in the surgical group versus 2 eyes in the conservative group (p < 0.0001). This effect was maintained throughout the follow‐up period, for the surgical group and reached up to 70%, for the medical group. At every follow‐up, BCVA was better in the surgical group, but this was only statistically significant at 1 and 3 months. The granuloma appeared as a homogenous hyperreflective lesion in examined eyes (16 eyes of 15 patients). Conclusion Surgical treatment of large granulomas leads to a more complete and rapid resolution of inflammation.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Anterior chamber granuloma: conservative treatment versus surgical intervention

Sadek

Ahmed

Kamal

et al. 2020

Acta Ophthalmologica

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Metagenomic analysis of the ocular toxoplasmosis in children uveitis from Fayoum governorate, Egypt

Elmallawany,

Abdel-Aal,

Abu Eleinen

et al. 2024

Infection, Genetics and Evolution

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Management of presumed trematode-induced granulomatous intermediate uveitis

Amin

Abdullatif

2022

Eye

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Purpose To describe the surgical management of presumed trematode-induced granulomatous intermediate uveitis (PTIGIU) not responding to medical treatment in controlling the inflammation. Methods A prospective, interventional, single-center study in which patients with a history of fresh canal water contact and PTIGIU were enrolled. All patients underwent lensectomy–pars plana vitrectomy (PPV) and post-operative control of inflammation, functional and anatomical outcomes were assessed. Results Fifteen eyes of 12 patients were included in the study with median age of 11.6 ± 4 yrs. Six months following lensectomy-PPV, inflammation was well controlled in all patients. The eyes were divided into two groups: Group A: 10 patients with an attached retina while Group B: 5 patients who were in the cicatricial stage with tractional retinal detachment. All patients in group A had CDVA of 20/40 or better, unlike patients in group B who failed to achieve a CDVA better than 20/70 throughout their follow-up. In group B, final anatomical success was achieved in only 40% with hypotony occurring in 20%. Conclusion PTIGIU is associated with the presence of ciliary body granuloma which, if left untreated, can lead to drastic outcomes. Early lensectomy-PPV represents a viable management option in cases resistant to medical treatment, with a favorable outcome.

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Management of presumed trematode induced granulomatous uveitis in pediatric patients

Cited by 8 publications

References 30 publications

Anterior chamber granuloma: conservative treatment versus surgical intervention

Anterior chamber granuloma: conservative treatment versus surgical intervention

Metagenomic analysis of the ocular toxoplasmosis in children uveitis from Fayoum governorate, Egypt

Management of presumed trematode-induced granulomatous intermediate uveitis

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