Be aware of severe juvenile chronic iridocyclitis without evidence of arthritis: Juvenile chronic iridocyclitis revisited

Abstract

Be aware of severe juvenile chronic iridocyclitis without evidence of arthritis: Juvenile chronic iridocyclitis revisited Dear Editor, Although the etiology of juvenile non-infectious uveitis varies, 1-3 its clinical course is sometimes refractory and carried a risk of poor visual outcome. [2][3][4][5] Juvenile idiopathic arthritis (JIA) -associated uveitis is an example of such a case. 2-8 However, some children with severe chronic uveitis that is very similar to JIA-associated ocular lesions do not exhibit any evidence of arthritis throughout the clinical course. 1,2 We treated three children with severe idiopathic uveitis without evidence of JIA. One patient required repeated surgical procedures for the sequelae of persistent ocular inflammation. Although all patients were treated with topical and systemic corticosteroids combined with intravitreal anti-vascular endothelial growth factor (anti-VEGF), ocular inflammation was not adequately controlled. We successfully treated them with tumor necrosis factorα inhibitors (TNFi). [1][2][3][4][5] In clinical practice, physicians should be aware of the underlying severity of pediatric uveitis. 3 In this context, we emphasized severity of pediatriconset, non-infectious refractory chronic uveitis without JIA, previously referred to as juvenile chronic iridocyclitis (JCI). 1All three patients were referred to us by the Ophthalmology Department of our hospital. The patients had already received oral prednisolone and topical treatment; however, their ocular inflammation persisted. Patient 1 was a 13-year-old Japanese boy with a 6-year history of bilateral refractory chronic iridocyclitis.Aggressive regional treatment (topical betamethasone and periocular glucocorticoids plus intravitreal anti-VEGF administration) and oral prednisolone had been initiated. Then, we initially treated him with cyclosporin A (125 mg daily with the peak blood level of the