Clinical and Pathological Characteristics of Presumed Trematode-Induced Granulomatous Uveitis in Egyptian Pediatric Patients Referred to Memorial Institute Kids Eye Unit.

PURPOSE: To fully characterize the clinical and pathological characteristics of PTIGU (Presumed Trematode-Induced Granulomatous) in pediatric patients and therefore enhance its diagnostic accuracy and treatment modalities.

METHODS

A retrospective descriptive observational study was conducted at the specialized uveitis clinic of MIKE (Memorial Institute for Kids' Eye unit), Memorial Institute for Ophthalmic Research, Giza, Egypt. The study involved 125 eyes of 105 children diagnosed with PTIGU. Comprehensive clinical evaluations were performed of both the anterior and posterior segments.

RESULTS

Granuloma classification by site revealed AC (anterior chamber) granuloma in 56.8%, CB (ciliary body granuloma) in 17.6%, and combined granuloma in 25.6% of cases. Other rare sites were lens (8%), corneal (10.4%), subconjunctival (3.2%), and iris granuloma (8.8%). The morphological patterns were mainly nodular. The pathological characteristics of the removed granuloma exhibit non-caseating granulomatous inflammation composed of marked fibrosis and inflammatory infiltrate composed of lymphocytes, epithelioid cells, and sidero-/melanophages with an eosinophilic infiltrate. The granuloma area and the occurrence of complications were substantially correlated (p-value < 0.001). Comparison of the visual acuity outcomes represents significant differences in pre- and post-treatment. There was no statistically significant difference in the visual acuity outcome between the conservative and surgical treatments.

CONCLUSION

Trematode granuloma exhibits several clinical presentations. We documented ciliary body granuloma in the absence of anterior chamber granuloma, and several atypical manifestations, including concomitant episcleral, corneal, iris, and lens granulomas; hypopyon and hyphema. Conservative management should be initiated promptly in all instances. Surgical intervention is warranted solely in complex cases or in eyes unresponsive to conservative care.