Abstract
Purpose :
To evaluate the outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections for macula edema secondary to non-infectious uveitis.
Methods :
The records of patients that received anti-VEGF injections for uveitic macula edema from January 2017 to August 2021, allowing for at least 180 days of follow-up, were reviewed. Excluded were eyes with a history of infectious uveitis and macula edema secondary to non-uveitic conditions. The primary outcomes were mean change in visual acuity (VA) and central subfield thickness (CST) over 6 months [and 12 months if available] from the start of anti-VEGF treatment. Secondary outcomes were the proportion of eyes that required additional local therapy (including periocular/intraocular steroid injections) or escalation in systemic treatment (including oral steroids or immunomodulatory therapy).
Results :
A total of 16 eyes (of 12 patients) met the inclusion criteria. Of these, 63% had panuveitis, 6% posterior uveitis, and 31% intermediate uveitis. Three-fourths of eyes (75%) starting anti-VEGF treatment had a history of elevated intraocular pressure secondary to a steroid response. Aflibercept was the most frequently injected anti-VEGF agent (in 88% of eyes) and the remaining received bevacizumab injections (12% of eyes). The mean VA gain at 6 months was 3.2 letters from a mean VA of 62.3 letters at baseline while mean CST improved by 101 μm from 445 μm at baseline. Three-quarters of eyes (75%) demonstrated a reduction in CST after their initial injection. Fourteen eyes had a 12 month visit from the start of treatment. The mean VA at 12 months remained similar to their baseline while the CST improved by a mean of 83 μm. Eyes received a median of 4 injections from 11 visits over 12 months. Only 1 eye required the addition of a dexamethasone implant in 6 months, with an additional eye requiring it over 12 months. One-tenth of eyes (10%) required an escalation in systemic treatment over 6 months [5% of eyes over 12 months]. IOP remained relatively stable (with a mean change of 0.4mm Hg over 6 months and -3.7 mm Hg over 12 months).
Conclusions :
Eyes with non-infectious uveitic macula edema, particularly those intolerant to local steroid injections, may benefit from anti-VEGF injections. Larger studies on the long-term outcomes of VEGF inhibition may establish their role in preventing vision loss in patients with uveitic macular edema.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.