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Francesco Pichi, Kimberly Baynes, Paolo Nucci, Careen Y Lowder, Sunil K Srivastava; Sustained-release dexamethasone intravitreal implant in juvenile idiopathic arthritis-related uveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5301.
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© ARVO (1962-2015); The Authors (2016-present)
To present a series of patients with JIA uveitis treated with dexamethasone implant (Ozurdex®).
Retrospective chart review.
Seventeen eyes of 12 patients (10 girls, mean age 12.5±6.7 years) with JIA uveitis received intravitreal Ozurdex®. Mean duration of: arthritis before starting treatment with Ozurdex was 49±35.6 (12-132) months; uveitis was 31±20.1 (12-72) months; follow-up was 11.6±13.2 (2-24) months. One month after injection, vision improved to 40.2±11 logMAR (p<0.001). Seven of 8 eyes that received Ozurdex for persistent iritis had resolution by clinical exam. Nine of 17 eyes had macular edema prior to injection with central retinal thickness of 437.6±96.2 µm that decreased to 342.4±79.3 µm (p<0.01) at one month. Twelve of 17 eyes received a second implant at 7.5±3.1 months after first injection. One month after second implant, iritis resolved in 11 eyes (91.6%), mean BCVA improved to 44.6±8.1 logMAR (p<0.01). Five of 12 eyes had macular edema at second injection with central retinal thickness of 399.8±59.8 µm that improved to 250.4±13.7 µm (p<0.01) in 4/5 eyes at one month. Five eyes received a third Ozurdex iimplant 7±4.6 months after second injection; of these 5 eyes, 4 had iritis and 1 had macular edema. One eye received a fourth injection 3 months after the third for iritis. Five of 17 eyes were pseudophakic prior to first injection. Of the remaining 12, 8 (66.6%) developed worsening posterior subcapsular cataract at a mean of 7.3±1.2 months after first implant. Three of these 8 eyes required cataract surgery 10.7±4.8 months from initial injection. Prior to Ozurdex injection, none of the 17 eyes was on anti-glaucoma therapy. After the first injection, 1 eye required therapy with maximum IOP of 25 mmHg. Mean IOP prior to first injection was 15 mmHg; at 1 month, 25 and at 3 months, 23. In the 12 eyes that received a second injection, mean IOP was 13.4±1.3 mmHg at the time of injection, 14.6±0.8 at 1 month and 15.3±1.1 at 3 months. None of the eyes receiving 3 or 4 injections developed IOP rises.
Our series suggests that Ozurdex can be effective in the treatment of JIA-associated uveitis and macular edema with few side effects.
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