1. Anterior Uveitis in a Child
Manfred Zierhut
Centre of Ophthalmology
University of Tuebingen, Germany

2. Ocular History anterior uveitis known since 2001
since then topical corticosteroids

3. Ocular History at Presentation
9 year old boy, German origin
red eye
light sensitive
pain
slow visual reduction since 2 months

4. General History scoliosis
„noises from the heart“, investigation was normal

5. First Presentation – Ocular Examination
VA: OD: 0,4 / OS: 1,25
IOP: 22 / 14 mmHg
OD:
small endothelial precipitates
AC cells (3+), no posterior synechiae
1+ cells in the anterior vitreous
OS: regular

6. First Presentation - Fundus
OD:
mild edema of the optic disc
macula edema
Amsler Grit:
OD: metamorphopsia
OCT: cystoid macula edema 805 µm.
OS: regular

8. Diagnosis from the transfering Ophthalmologist
Panuveitis
suggestive for HSV-Infection

9. Therapy Suggestion from the transfering Ophthalmologist
Triamcinolone intravitreally

10. Our Diagnosis
Anterior uveitis
with Macula edema

11. Treatment Decortin H (1 mg/kg bodyweight, 50 mg/d)
Acetacolamide (2x 125 mg/day)

12. Follow up - After 1 Month
December 2004:
OCT: OD macula dry
VA: OD 0,5
IOP 34/22 mmHg

14. Follow Up – After 2 Months
January 2005:
VA OD 0,6p
IOP 30/22 mmHg
hospitalization
suggestive for steroid-responder
good response to antihypertensive treatment

15. Conclusion
macular edema is a complication of all anatomical types of uveitis and not automatically leading to the name of „panuveitis“
macular edema in HSV-induced anterior uveitis is very rare
in steroid-responders intravitreal corticosteroids can be deleterious, esp. in children
acetacolamid can be very effective in the treatment of macular edema