儿童眼结节病1例(英文)

Childhood ocular sarcoidosis:a case report

结节病是一种罕见的和潜在的致残儿科疾病。此病临床治疗困难,需要长期监测。我们报告了1例9岁的白人女孩的情况,就诊最初表现为双侧慢性前葡萄膜炎、白内障和继发于结节病的青光眼。在过去的2a,患者接受左布诺洛尔滴剂,局部和全身类固醇治疗,随后要求折叠式人工晶状体植入。在白内障手术后的2mo,患者葡萄膜炎以局部类固醇和低剂量甲氨蝶呤一直控制良好。她全血计数和肾功能定期监测,没有甲氨蝶呤不良影响的报告。结节病是一多系统疾病,需要眼科学家,神经学家和儿科医师多学科的投入。内科和外科治疗本病富于挑战。本例强调了低剂量甲氨蝶呤在儿童慢性葡萄膜炎治疗中的安全性和对此病及时治疗以防止显著发病的需要。

Sarcoidosis is a rare and potentially disabling disease in the paediatric age group. Clinical management of such cases is difficult and requires long-term monitoring. We report a case of a 9 years old Caucasian girl who presented initially with bilateral chronic anterior uveitis, cataracts and glaucoma secondary to sarcoidosis. She was treated with Guttae Levobunolol, topical and systemic steroids over the last 2 years but subsequently required cataract extractions with foldable intraocular lens implants （Alcon Laboratories, Inc. Acrysof IOL Model： MA60AC）. Her uveitis was well controlled with both topical steroids and low dose methotrexate over the last 2 months following cataract surgery. Her full blood counts and renal functions are monitored regularly. There was no adverse effect from the methotrexate reported so far. Sarcoidosis is a multisystem disease and requires multi-disciplinary input from ophthalmologists, neurologists and paediatricians. Medical and surgical treatment of such ocular manifestations is challenging. This case highlights both the safety of low dose methotrexate in the management of childhood chronic uveitis and the need for prompt treatment in such cases to avert significant morbidity from this disease.