Intravenous tocilizumab in idiopathic pediatric uveitis with refractory cystoid macular edema - A case report

Abstract

A 13-year-old boy with a 4-year history of idiopathic pediatric uveitis and recurrent uveitic macular edema had failed conventional immunomodulatory therapy and presented to us with a vision of 6/24 [right eye (OD)] and 6/9 [left eye (OS)]. Fluorescein angiography showed diffuse vascular leakage along with cystoid macular edema (CME). Intravenous tocilizumab (10 mg/kg body) was given as 14 injections over 12 months. Repeat fluorescein angiography every 3 months showed a dramatic improvement in the vascular leakage and resolution of CME. At 13 months OF follow-up, vision had improved to 6/9p (OD) and 6/6(OS) with no recurrence of inflammation or CME.

Keywords: Biologics; cystoid macular edema; idiopathic; pediatric uveitis; tocilizumab.

Figure 1

Fundus photographs of right (a) and left eyes (b) showing vitritis in the right eye with otherwise normal looking posterior pole with corresponding OCTs showing cystoid changes in the fovea in the right (c) and hyperreflective dots in the inner retina in the left eye (d)

Figure 2

Fluorescein angiography showing diffuse vascular leakage, increasing toward the later phases, a hot disc and leakage at the macula suggestive of cystoid macular edema with corresponding indocyanine green angiography of the right (a) and left eyes (b). The ICG pictures are noncontributory

Figure 3

Fluorescein angiography after 3 months of intravenous tocilizumab showing decrease in vascular leakage, resolution of cystoid macular edema and reduced leakage from the optic discs in right (a) and left eyes (b)

Figure 4

Fluorescein angiography at 6 months (a and b) and 13 months (c and d) after initiation of intravenous tocilizumab, showing further decrease in vascular leakage, no cystoid macular edema or leakage from the optic discs in right and left eyes