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Treatment of refractory uveitic macular edema with dexamethasone intravitreal implants in a pediatric patient with bilateral granulomatous idiopathic panuveitis: a case report.

Bourgault S, Aroichane M, Wittenberg LA, Lavallée A, Ma PE - J Ophthalmic Inflamm Infect (2013)

Bottom Line: Three months later, his vision had improved from 20/200 in both eyes to 20/30 in the right eye and 20/40 in the left eye.Optical coherence tomography showed complete resolution of the cystoid macular edema and subretinal fluid in both eyes.This is a rare report of the use of bilateral dexamethasone intravitreal implant in a pediatric patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia V5Z 3N9, Canada. serge.bourgault.1@ulaval.ca.

ABSTRACT

Background: Macular edema is a common complication of uveitis and represents a therapeutic challenge, especially in children. Recently, intravitreal dexamethasone implants have been shown to decrease intraocular inflammation and to control uveitic macular edema in patients with non-infectious intermediate or posterior uveitis.

Findings: An 11-year-old boy with bilateral granulomatous idiopathic panuveitis and orbital inflammation experienced macular edema refractory to topical steroids and subcutaneous methotrexate. He was treated with off-label bilateral injections of dexamethasone intravitreal implant. Three months later, his vision had improved from 20/200 in both eyes to 20/30 in the right eye and 20/40 in the left eye. Optical coherence tomography showed complete resolution of the cystoid macular edema and subretinal fluid in both eyes.

Conclusions: This is a rare report of the use of bilateral dexamethasone intravitreal implant in a pediatric patient. The implants achieved complete resolution of the uveitic macular edema with no adverse events 3 months post-implantation.

No MeSH data available.


Related in: MedlinePlus

Optical coherence tomography before bilateral injections of dexamethasone intravitreal implant. Optical coherence tomography showed marked cystoid macular edema in the right eye. (top) The left eye showed subretinal fluid and minimal cystoid macular edema (bottom). The central retinal thickness was 592 μm in the right eye and 435 μm in the left eye.
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Figure 2: Optical coherence tomography before bilateral injections of dexamethasone intravitreal implant. Optical coherence tomography showed marked cystoid macular edema in the right eye. (top) The left eye showed subretinal fluid and minimal cystoid macular edema (bottom). The central retinal thickness was 592 μm in the right eye and 435 μm in the left eye.

Mentions: Over the last 3 months, his best-corrected visual acuity had decreased from 20/40 in the right eye (OD) and 20/30 in the left eye (OS) to 20/200 in both eyes (OU). Slit lamp examination showed mutton-fat keratic precipitates, 4+ anterior chamber cells, and 3+ flare. Both eyes showed 4+ vitreous cells. Dilated fundus examination showed bilateral disc edema, dilated and sheathed veins, and macular edema. Optical coherence tomography (OCT) showed CME and subretinal fluid with a central foveal thickness of 592 μm OD and 435 μm OS (Figure 2). His treatment regimen included prednisolone drops 1% every hour, dexamethasone ointment 0.1% and homatropine drops 2% bid OU, subcutaneous methotrexate 20 mg weekly, and oral folic acid 2 mg daily.


Treatment of refractory uveitic macular edema with dexamethasone intravitreal implants in a pediatric patient with bilateral granulomatous idiopathic panuveitis: a case report.

Bourgault S, Aroichane M, Wittenberg LA, Lavallée A, Ma PE - J Ophthalmic Inflamm Infect (2013)

Optical coherence tomography before bilateral injections of dexamethasone intravitreal implant. Optical coherence tomography showed marked cystoid macular edema in the right eye. (top) The left eye showed subretinal fluid and minimal cystoid macular edema (bottom). The central retinal thickness was 592 μm in the right eye and 435 μm in the left eye.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016568&req=5

Figure 2: Optical coherence tomography before bilateral injections of dexamethasone intravitreal implant. Optical coherence tomography showed marked cystoid macular edema in the right eye. (top) The left eye showed subretinal fluid and minimal cystoid macular edema (bottom). The central retinal thickness was 592 μm in the right eye and 435 μm in the left eye.
Mentions: Over the last 3 months, his best-corrected visual acuity had decreased from 20/40 in the right eye (OD) and 20/30 in the left eye (OS) to 20/200 in both eyes (OU). Slit lamp examination showed mutton-fat keratic precipitates, 4+ anterior chamber cells, and 3+ flare. Both eyes showed 4+ vitreous cells. Dilated fundus examination showed bilateral disc edema, dilated and sheathed veins, and macular edema. Optical coherence tomography (OCT) showed CME and subretinal fluid with a central foveal thickness of 592 μm OD and 435 μm OS (Figure 2). His treatment regimen included prednisolone drops 1% every hour, dexamethasone ointment 0.1% and homatropine drops 2% bid OU, subcutaneous methotrexate 20 mg weekly, and oral folic acid 2 mg daily.

Bottom Line: Three months later, his vision had improved from 20/200 in both eyes to 20/30 in the right eye and 20/40 in the left eye.Optical coherence tomography showed complete resolution of the cystoid macular edema and subretinal fluid in both eyes.This is a rare report of the use of bilateral dexamethasone intravitreal implant in a pediatric patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia V5Z 3N9, Canada. serge.bourgault.1@ulaval.ca.

ABSTRACT

Background: Macular edema is a common complication of uveitis and represents a therapeutic challenge, especially in children. Recently, intravitreal dexamethasone implants have been shown to decrease intraocular inflammation and to control uveitic macular edema in patients with non-infectious intermediate or posterior uveitis.

Findings: An 11-year-old boy with bilateral granulomatous idiopathic panuveitis and orbital inflammation experienced macular edema refractory to topical steroids and subcutaneous methotrexate. He was treated with off-label bilateral injections of dexamethasone intravitreal implant. Three months later, his vision had improved from 20/200 in both eyes to 20/30 in the right eye and 20/40 in the left eye. Optical coherence tomography showed complete resolution of the cystoid macular edema and subretinal fluid in both eyes.

Conclusions: This is a rare report of the use of bilateral dexamethasone intravitreal implant in a pediatric patient. The implants achieved complete resolution of the uveitic macular edema with no adverse events 3 months post-implantation.

No MeSH data available.


Related in: MedlinePlus