Author: Marta Rodrigues Correia (Portugal)
Co-authors: Miguel Cordeiro, Carolina Bruxelas, Mariana Portela, Marta Guedes
Assess the 2-year outcome of fluocinolone acetonide intravitreal implant (FAc) treatment in the prevention of idiopathic granulomatous panuveitis relapse and control of secondary recurrent cystoid macular edema (CME).
Uveitis outpatient clinic, Ophthalmology Department, Egas Moniz Hospital – Centro Hospitalar de Lisboa Ocidental.
Review of a clinical case of recurrent macular edema secondary to bilateral idiopathic granulomatous panuveitis, in which a fluocinolone acetonide intravitreal implant (FAc) was injected in the left eye (LE). The outcome measures evaluated included best-corrected visual acuity (BCVA; logMAR), central foveal thickness (CFT; µm), intra-ocular pressure (IOP; mmHg), number of intravitreal injections and cataract development.
45-year-old female presented to our clinic with a 5-year history of red eye, ocular pain, photophobia, decreased vision and multiple intravitreal steroid injections. After extensive workup a diagnosis of chronic bilateral idiopathic granulomatous panuveitis was made. During the next 6 years of follow-up there were multiple recurrences of uveitis and CME despite treatment with different doses of oral corticosteroids and methotrexate. A total of 2 injections of triamcinolone (TCN) and 1 dexamethasone intravitreal implants (DEX) in the right eye (RE) and 1 DEX in the LE were needed. In the next LE CME recurrence, 1 intravitreal injection of FAc was given. The patient had already had cataract surgery in both eyes. During the 2-year period after LE FAc injection there was no recurrence of uveitis or of the CME (CFT 582 µm to 351 µm), with a BCVA improvement (0.4 to 0.2, + 10 letters) in the LE. Although there was no uveitis relapse in the RE during the same period, there was epiretinal membrane development with secondary macular hole due to CME relapses, requiring 3 more DEX implants. The patient was already under topical IOP-lowering medication prior to injection, requiring no further treatment.
FAc was safe and effective in the treatment and control of recurrent macular edema and inflammation in this case of granulomatous idiopathic panuveitis. The use of an adjunctive intravitreal injection with a prolonged half-life allowed to reduce systemic immunosuppression, decreased complications associated with fluctuations of CFT and ameliorated the total disease burden.