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Miguel Cordero Coma, Ricardo Blanco, Carmen Bejerano, Emma Beltrán, Alex Fonollosa, Olga Maiz, Ana Blanco, Joaquin Cañal, Juan Ventosa, Miguel Angel Gonzalez Gay; High Dose Intravenous Methylprednisolone Induces Rapid Improvement In Severe Uveitis: A Multicenter Study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1182.
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To evaluate high-dose intravenous methylprednisolone (IVMP) as initial remission therapy for the treatment of severe uveitis.
We retrospectively reviewed charts from 26 patients (43 eyes) with severe uveitis from 4 tertiary Hospitals who received therapy with IVMP. The underlying diseases were: Idiopathic uveitis (n=11, 42%), Vogt Koyanagy Harada syndrome (n=9, 34%), Behçet disease (n=2), Ankylosing Spondylitis (n=1), Eales Disease (n=1), Sympathetic Ophthalmia (n=1), Multiple Sclerosis (n=1), Relapsing Polychondritis (n=1), Varicella-Zoster-associated acute retinal necrosis (n=1). The inflammatory ocular patterns were: posterior uveitis (n=12, 46%), panuveitis (n=11, 42%), anterior uveitis (n=1), sclero-uveitis (n=1), and intermediate uveitis (n=1). Bilateral ocular involvement was observed in 19 patients (73%). Patients were assessed at day 2-3, 7, 14 and 30 after ivMP treatment.
We studied 16 women/10 men with mean age 41.7±15.2 years. IVMP dose ranged from 0.25-1 g/day for 3-5 consecutive days. All of them had active intraocular inflammation at baseline. Following IVMP therapy patients with anterior uveitis experienced rapid improvement. However, improvement of retinal vasculitis was more slowly achieved. Exudative retinal detachment occurred in 10 patients (19 eyes) showing partial improvement of affected eyes in 11% at day 2-3 and a complete recovery in 74% at day 30. Optical coherence tomography showed impairment in 14 patients (26 eyes) at baseline, partial improvement in 46% of affected eyes at day 2-3 and a complete normalization in 54% at day 30. Visual acuity was reduced in 26 patients (43 eyes) at baseline. Thirty-five eyes (81%) improved in visual acuity, 5 eyes (11%) remained stable and 4 eyes (9%) had worsened at day 30. The patient with acute retinal necrosis presented progressive improvement and inactive lesions at day 30. IVMP therapy was well tolerated and no important side-effects were observed.
IVMP seems an effective and safe remission induction therapy in severe intraocular inflammation. Further studies on this matter are warranted.
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