COMBINATION OF INTRAVITREAL STEROID IMPLANTS_A RESCUE STRATEGY FOR THE TREATMENT OF CHRONIC PANUVEITIS
Purpose
To report the case of a 73 year old female patient with bilateral visual loss secondary to panuveitis and to propose the best timing for intravitreal steroid treatment
Methods
Case-report
Results
On April 2021, the patient was admitted to the ED due to severe, recurrent, OS vision loss. The ophthalmologic exam revealed bilateral vision loss (OD CF; OS 20/400), bilateral active anterior uveitis and vitreous haze (OD 3+ and OS 2+). SD-OCT and fluorescein angiography (FA) revealed left eye cystoid macular edema and non-occlusive retinal vasculitis. The patient started oral steroids with insufficient compliance and underwent the first OS intravitreal dexamethasone implant (Ozurdex@) in July 2021, with excellent response. Two more intravitreal dexamethasone implants were injected in the OS, followed by intravitreal fluocinolone acetonide implant (Iluvien@), in May 2022. Multidisciplinary approach pointed to a possible bilateral Panuveitis in the setting of Psoriatic Arthritis. The patient started metothrexate in May 2022 with good tolerance. On the last follow-up visit, in January 2023, OS best corrected visual acuity was 20/30, there was no active anterior uveitis, residual vitreous haze (< 1+) and significant anatomic improvement was noticed.
Conclusion
Intravitreal steroids are a valuable treatment option for uveitis patients with poor compliance or contra-indication to systemic therapies. It seems advisable to perform long-duration fluocinolone acetonide injection (Iluvien@) shortly after uveitis control in response to intravitreal dexamethasone implant injection (Ozurdex@). This strategy may provide prompt and longterm inflammation control.
Conflict of interest
No
Authors 1
Last name
FURTADO
Initials of first name(s)
MJ
Department
Centro Hospitalar de Santo António
City
Porto
Country
Portugal
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