Anthony DeFino , 2025-05-09 18:00:00
Key Takeaways:
- Surgical intervention for pediatric pars planitis may be necessary if immunosuppression is ineffective.
- Know the complications of scleral buckling with or without pars plana vitrectomy.
FORT LAUDERDALE, Fla. — In some cases of pediatric pars planitis, surgical intervention may be necessary, but possible complications must be considered, according to a speaker.
At the Retina World Congress, Lisa J. Faia, MD, discussed a case in which a 12-year-old patient with inflammation secondary to pars planitis initially showed improvement after treatment with difluprednate followed by dorzolamide, oral steroids and mycophenolate. After 1 year, however, symptoms returned despite treatment with immunosuppressants.
Image: Anthony DeFino
“The inflammation improved, but inferior contraction started to develop over the next year, and tractional retinal detachment progressed inferiorly,” Faia said.
Faia decided to perform scleral buckling without pars plana vitrectomy (PPV) due to possible complications associated with PPV, including the progression of cataract and increased risk for proliferative vitreoretinopathy (PVR).
“Currently, his vision is doing well, and he is on adalimumab just once a month,” she said.
According to Faia, while PPV is an effective approach to reduce inflammation that leaves room for future trabeculectomy, it may also make lifting the hyaloid in younger patients more difficult. Comparatively, scleral buckling relieves vitreomacular traction but is difficult to perform and may cause refractive error as well as amblyopia in some patients.
When considering a surgical approach for uveitis, ophthalmologists should first perform a biopsy for proper diagnosis and prioritize treating vision-threatening etiologies and reducing inflammation, Faia said. She also highlighted the prevalence of retinal detachment in patients with pars planitis, which occurs in about 10% of patients, as well as a higher rate of PVR.
Other well-known surgical complications of pars planitis include band keratopathy, cataract, glaucoma, epiretinal membrane, vitreous opacities and retinoschisis.
According to Faia, surgical intervention in patients with pediatric uveitis “may be required for structural changes if immunosuppression is not enough. A repair depends not only on age but is specific to what you are looking for. And, when possible, obtain quiescence of inflammation.”
Sources/Disclosures
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Faia LJ. Surgery in pediatric uveitis patients: When immunosuppression is not enough. Presented at: Retina World Congress; May 8-11, 2025; Fort Lauderdale, Florida.
Disclosures:
Faia reports being on the speakers bureau for AbbVie, Allergan, ANI Pharmaceuticals, Astellas, Genentech and Regeneron and the advisory board for EyePoint Pharmaceuticals, Ocular Therapeutix and Regeneron.
