Intravenous Pulsed Corticosteroids for Ocular Inflammatory Diseases

Abstract

Purpose: : To evaluate the effectiveness and risk of complications of high-dose intravenous pulsed corticosteroids for non-infectious ocular inflammatory diseases.

Methods: : 108 eyes of seventy patients receiving pulsed intravenous corticosteroids for control of non-infectious ocular inflammatory disease were retrospectively identified at five centers. Visual acuity, level of inflammation, ocular examination features, and ocular or systemic complications were recorded by medical record review at every visit.

Results: : Approximately one-half of eyes achieved complete control of inflammation at one month after initiation of treatment (57%; 95% CI: 33-83%) and the majority of eyes achieved at least partial control (82%; 95% CI: 61-96%). By disease subtype, 54.7% (95% CI: 29.8-83.0%) of eyes with intraocular inflammatory disease attained complete control at one month versus 51.9% (95% CI: 25.6-83.7%) of non-uveitic eyes (mucous membrane pemphigoid, scleritis, etc.). Overall, most eyes (85%; 95% CI: 70-95%) exhibited clinically significant improvement in anterior chamber inflammation, whereas vitreous cells were less responsive (48%; 95% CI: 32-67%). There was a trend towards achieving 20/40 or better vision at one month (p=0.06). One patient developed a colon perforation during the three days of treatment and one had difficulty controlling diabetes mellitus following the infusion. No other systemic complications were recorded.

Conclusions: : Treatment of ocular inflammation with pulsed intravenous corticosteroids appears to be effective at one month for all major forms of ocular inflammatory disease. Minimal ocular and systemic complications were observed as a side effect of treatment. Further studies and follow-up are needed to fully investigate the potential of this therapy.

Keywords: inflammation • uvea • clinical (human) or epidemiologic studies: outcomes/complications