Fluocinolone acetonide intravitreal implant to treat and prevent flares of bilateral anterior uveitis associated with multiple sclerosis
Author: Miguel Cordeiro (Portugal)
Co-authors: Marta Correia, Carolina Bruxelas, Margarida Baptista, Marta Guedes
Assess the use of fluocinolone acetonide intravitreal implant (FAc) in the treatment and prevention of flares in bilateral anterior granulomatous uveitis with secondary macular edema in a patient with multiple sclerosis.
Uveitis outpatient clinic, Ophthalmology Department, Egas Moniz Hospital – Centro Hospitalar de Lisboa Ocidental.
The authors describe a clinical case of a multiple sclerosis female patient with bilateral anterior granulomatous uveitis in which an fluocinolone acetonide intravitreal implant (FAc) was injected in both eyes. The outcome measures evaluated included best-corrected visual acuity (BCVA; logMAR), central foveal thickness (CFT; µm) and systemic immunosuppressive treatment changes.
A 63-year-old female with a seven-year follow-up at our uveitis clinic due to a bilateral idiopathic anterior granulomatous uveitis treated with long term oral methotrexate (MTX) presented to the Neurology department with ataxia, diplopia and nystagmus. After extensive workup, with MRI and lumbar puncture, a multidisciplinary approach revised the initial diagnosis and labeled the uveitis as associated with multiple sclerosis. High dose intravenous corticosteroids were initiated resulting in complete resolution of the neurological symptoms. Systemic immunosuppression was changed to peginterferon B-1a (IFNB). The uveitis relapsed one month later, with the patient presenting with 0.3 and 0.2 logMAR vision in the right and left eye, respectively, 2+ cells in the anterior chamber with extensive granulomatous keratic precipitates and bilateral cystoid macular edema. Treatment with high dose oral and topical prednisolone and cycloplegics was started. Since there was a history of low treatment compliance and IFNB wasn’t effective in preventing uveitis flares, a bilateral intravitreal implant of fluocinolone acetonide was injected. Complete resolution of the iridocyclitis and macular edema ensued (CFT µm), and visual acuity improved to 0.1 and 0.0 logMAR RE and LE respectively, with gradual and complete tapering of steroid therapy.
FAc was a safe and effective adjunctive treatment strategy in this case, allowing the complete tapering of the topical and systemic steroid therapy and sustained ocular inflammation control.
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