Purpose: To report a case of effective Janus kinase inhibitor treatment in a case of anterior uveitis complicated by macular edema in a patient with juvenile idiopathic arthritis. Case report: A 22-year-old woman suffering from JIA-associated anterior uveitis since the age of 2 years presented with recurrent active uveitis and macular edema in both eyes responding only to intraocular dexamethasone implants in the past while several other DMARD therapies including biologicals failed to control activity and edema. After starting treatment with tofacitinib 5 mg twice daily arthritis, uveitis, and macular edema were controlled without any further steroid implants. Conclusion: In this case, Janus kinase inhibitor represented a successful strategy for severe refractory uveitis and ME and therefore Janus kinase inhibitor may be an option in selected cases not responding properly to conventional synthetic and biologic DMARDs or to intraocular steroid implants.

Uveitis in juvenile idiopathic arthritis (JIAU) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first line therapy, and disease modifying anti-rheumatic drugs (DMARDs) are commonly used. However, treatment has not been standardized. Interdisciplinary guideline were developed with representatives from the German Ophthalmological Society, Society for Paediatric Rheumatology, Professional Association of Ophthalmologists, German Society for Rheumatology, parents' group, moderated by the Association of the Scientific Medical Societies in Germany. A systematic literature analysis in MEDLINE was performed, evidence and recommendations were graded, an algorithm for anti-inflammatory treatment and final statements were discussed in a consensus meeting (Nominal Group Technique), a preliminary draft was fine-tuned and discussed thereafter by all participants (Delphi procedure). Consensus was reached on recommendations, including a standardized treatment strategy according to uveitis severity in the individual patient. Thus, methotrexate shall be introduced for uveitis not responding to low-dose (≤ 2 applications/day) topical corticosteroids, and a TNFalpha antibody (preferably adalimumab) used, if uveitis inactivity is not achieved. In very severe active uveitis with uveitis-related deterioration of vision, systemic corticosteroids should be considered for bridging until DMARDs take effect. If TNFalpha antibodies fail to take effect or lose effect, another biological should be selected (tocilizumab, abatacept or rituximab). De-escalation of DMARDs should be preceded by a period of ≥ 2 years of uveitis inactivity. An interdisciplinary, evidence-based treatment guideline for JIAU is presented.

Aim: To evaluate the success rates of transscleral diode cyclophotocoagulation (TD-CPC) for secondary glaucoma in patients with juvenile idiopathic arthritis (JIA) as primary surgical treatment. Methods: Retrospective chart review of 12 paediatric patients with JIA associated uveitis and secondary open angle glaucoma. Results: 21 eyes of the 12 patients had chronic anterior uveitis, 21 eyes had secondary open angle glaucoma, and 19 eyes were treated 41 times with TD-CPC. Patients underwent a mean of 2.15 treatment sessions per eye. Pretreatment intraocular pressure (IOP) was 30.2 (5.5) mm Hg before the first treatment, 30.5 (5.7) mm Hg before the second treatment, and 28.7 (6.3) mm Hg before the third treatment. Reduction of IOP 6 weeks after treatment was highest after the second and third treatments with 9.4 (8.8) and 8.7 (5.8) mm Hg, respectively and 5.2 (10.7) mm Hg after the first treatment. Qualified success (IOP ⩽21 mm Hg with glaucoma medication) was achieved at the end of follow up in six of 19 eyes (32%, follow up time 10.1 (9.3) months). Conclusion: TD-CPC as a primary surgical treatment in JIA patients, is often unsatisfactory in eyes with uveitic glaucoma.

To report squamous cell carcinoma (SCC) of the conjunctiva in patients with atopic eczema. A retrospective study of six patients with conjunctival SCC associated with atopic eczema. Clinical and pathologic records were reviewed. Ten patients with conjunctival SCC were seen from October 1999 to May 2002 at the Department of Ophthalmology at the University of Essen. Six of 10 patients had also atopic eczema. These six patients were treated either with local excision and ocular surface reconstruction or proton beam radiotherapy. None of the patients had local recurrences or metastases. Atopic eczema is a common dermatological disease. An association with conjunctival SCC has not been reported so far. Squamous cell carcinoma has also been found in patients with AIDS and other immunosuppressed individuals. The dysfunction of T lymphocytes found in these disorders might play a crucial role in the malignant transformation of conjunctival tissue. Because of the reported frequency of SCC, patients with atopic eczema should be monitored for abnormalities.

We retrospectively analysed the time of occurrence of elevated IOP in 30 JIA patients during the course of uveitis. Groups were defined as (1) during inactivity of inflammation (≤0.5 anterior chamber cells according to the Standardization of Uveitis Nomenclature classification),3 (2) during acute inflammation or (3) after intraocular surgery. IOP was measured by Goldmann applanation tonometry. The first instance of elevated IOP was documented if IOP was ≥24 mm Hg at two consecutive measurements. All …

Several case reports have been published on the effect of janus kinase inhibitors (JAK-I) on juvenile idiopathic arthritis-associated uveitis (JIAU). Both tofacitinib and baricitinib have been desc...