Author: Miguel Ruão (Portugal)
Co-authors: Jeniffer Jesus, Maria João Matias, Isabel Lopes-Cardoso, João Chibante
Purpose
Intermediate uveitis is a major anatomic category of uveitis with predominantly vitreous inflammation. Retinal vasculitis and macular edema are common complications of intermediate uveitis. In Europe, fluocinolone acetonide (FAc, 0.19 mg, ILUVIEN®) intravitreal implant is indicated for the prevention of relapse in recurrent non-infectious uveitis affecting the posterior segment of the eye. The purpose of this case report is to describe a bilateral case of idiopathic intermediate uveitis, treated with FAc implant.
Setting/Venue
This case report evaluates the effectiveness of FAc implant on eyes with intermediate uveitis, and it was recorded at Centro Hospitalar entre Douro e Vouga, Portugal.
Methods
Clinical case description of a male patient with bilateral intermediate uveitis treated with a single FAc implant. Functional (best corrected visual acuity [BCVA]) and inflammation markers parameters (presence of vitritis, vasculitis and cells in the anterior chamber [AC]) were analyzed during follow-up.
Results
Male patient, with 32 years-old, diagnosed with idiopathic anterior and intermediate uveitis since 2010. The patient underwent cataract surgery in both eyes, in 2014. Due to presence of vasculitis and vitritis, as well as presence of anterior uveitis, the patient underwent a course of intravitreal injections of dexamethasone in both eyes twice a year, since 2015, with successive good functional response and reduction in inflammation markers but relapsed every 6 months. No macular edema was observed in both eyes. Systemic therapy was started in April 2019 – prednisolone and cyclosporine. One month later, cyclosporine was discontinued due to lack of response. Later that year, the patient underwent bilateral FAc implant, in right eye(RE) in August 2019 and left eye (LE) in September 2019. BCVA pre-FAc implant was 20/20 on the RE and 20/60 on the LE. Two months after FAc implant, prednisolone therapy was tapered and discontinued, BCVA was presented as 20/20 on the RE and 20/60 on the LE and no signs of inflammation were observed. At present, 18 months after FAc implant, both eyes are quiescent, without presence of vitritis and anterior uveitis and BVCA has been sustained during this follow-up.
Conlusions
This case report suggests that FAc implant has a place in the treatment of chronic intermediate uveitis, both on the functional level, with improvement or stabilization of visual acuity and on the systemic therapy sparing level, with this avoiding the adverse events associated with systemic therapy with possible reduction or cessation of systemic treatment. Regarding inflammatory outcomes, FAc implant allows the eye to have a long quiescence period without any relapse of inflammation.
Financial Disclosure
nothing to declare
Comments
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