Outcome of Treating Pediatric Uveitis With Dexamethasone Implants

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• 作者：Oren Tomkins-Netzer ; ^{o.tomkins-netzer@ucl.ac.uk" class="auth_mail" title="E-mail the corresponding author}Author Vitae ; Lazha TalatAuthor Vitae ; Sophie Seguin-Greenstein ; Asaf Bar ; Sue Lightman
• 刊名：American Journal of Ophthalmology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：161
• 期：Complete
• 页码：110-115.e2
• 全文大小：958 K

文摘

To describe the outcome in children of eyes with uveitis following repeated treatment with dexamethasone (Ozurdex) implants.

Design

Retrospective, interventional study.

Methods

Twenty-two eyes of 16 pediatric patients with uveitis were treated with 35 dexamethasone implants at a tertiary referral center. Following implantations, anatomic and functional outcomes, as well as ocular complications, were noted. Main outcome measures included best-corrected visual acuity, central retinal thickness, number and dosage of systemic immunosuppression drugs, vitreous haze score, and presence of raised intraocular pressure or cataract.

Results

Following the first implantation, average best-corrected visual acuity improved significantly from 0.55 ± 0.08 logMAR to 0.37 ± 0.08 logMAR (P = .024), central retinal thickness decreased by 219 ± 55 μm (P = .01), and the percentage of eyes achieving a vitreous haze score of 0 increased from 41% to 88% (P = .006). The median time to relapse following the first injection was 9 months, with a similar response achieved after each repeat implantation. Children previously requiring systemic immunosuppression at the time of the first implantation were able to stop or significantly reduce the dose and number of drugs. In total there were 4 instances of cataract progression that were not visually significant and did not require surgical treatment and 6 cases of raised IOP, 5 of which were treated pharmacologically with no surgical intervention required and 1 that required revision of a previous filtration surgery. There were no cases of implant migration into the anterior chamber, endophthalmitis, or retinal detachment.

Conclusions

The use of dexamethasone implants in children results in improved retinal thickness and reduction in ocular inflammation, which can improve vision for several months. Repeat implantations result in continued control of the inflammation, allowing for reduction of systemic immunosuppression with few ocular complications.