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. 2021 Mar;10(1):193-200.
doi: 10.1007/s40123-020-00328-9. Epub 2021 Jan 19.

Bilateral 0.19 mg Fluocinolone Acetonide Intravitreal Implant in the Successful Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis and Secondary Macular Oedema: A Case Report and Review of Intravitreal Therapies

Abdus Samad Ansari  1 , Zain Amir  2 , Gwyn S Williams  2
Affiliations

Bilateral 0.19 mg Fluocinolone Acetonide Intravitreal Implant in the Successful Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis and Secondary Macular Oedema: A Case Report and Review of Intravitreal Therapies

Abdus Samad Ansari et al. Ophthalmol Ther. 2021 Mar.

Abstract

Introduction: Treatment of juvenile idiopathic arthritis (JIA)-associated uveitis necessitates the use of long-term corticosteroids or immunosuppressive agents, each of which poses their own significant side effect profile. Initial treatment requires intensive topical glucocorticoids, with a step-up approach employing immunosuppressive agents for those cases with poor response or high-risk complications such as macular oedema. To date, there is minimal evidence to support a specific approach to such complicated subgroups. We present the first case to successfully employ the 0.19 mg fluocinolone acetonide implant (ILUVIEN®, Alimera Sciences, Hampshire, UK) as a novel device for prolonged intravitreal administration of disease-modifying agents for patients with JIA complicated by uveitis.

Methods: This retrospective case report describes a 20-year old woman diagnosed with oligoarticular JIA complicated by chronic uveitis and associated cystoid macular oedema (CMO). Considering factors including the patient's non-compliance, age, lens status, non-steroid response, and good response to short-term intravitreal steroid therapy, the 0.19 mg fluocinolone acetonide intravitreal implant was deemed an appropriate step-up treatment option.

Results: At 12-month follow-up, the left eye (OS) showed an improvement in visual acuity to 6/15 - 1 from 6/60 + 1 (0.42 from 0.98 logMAR) (pre-insertion) and a reduction in central retinal thickness (CRT) of 199 μm from 471 μm. The right eye (OD), treated 10 months later, showed an improvement in visual acuity to 6/7.5 from 6/24 - 1 (0.10 from 0.56 LogMAR) and a reduction in CRT of 327 μm 6 months after treatment.

Conclusion: In this case, the 0.19 mg fluocinolone acetonide implant provided safe and effective long-term treatment of JIA-associated uveitis and secondary CMO. This potentially offers an alternative approach to complex cases that show good response to short-term corticosteroid use.

Keywords: Cystoid macular oedema; Fluocinolone acetonide; JIA; Uveitis.

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Figures

Fig. 1
Fig. 1
Right and left eye prior to treatment. Exhibiting significant vitreous haze, unable to determine severity of cystoid macular oedema in left eye due to severity of vitritis
Fig. 2
Fig. 2
Right eye 6 months after treatment and left eye 12 months after treatment. Exhibiting complete resolution of cystoid macular oedema and control of posterior segment inflammation
Fig. 3
Fig. 3
Patient care flow chart. VAR visual acuity right, VAL visual acuity left, RE right eye, LE left eye, OCT optical coherence tomography, CMO cystoid macular oedema, JIA juvenile idiopathic arthritis
See this image and copyright information in PMC

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References

    1. Hawkins MJ, Dick AD, Lee RJ, et al. Managing juvenile idiopathic arthritis–associated uveitis. Surv Ophthalmol. 2016;61:197–210. doi: 10.1016/j.survophthal.2015.10.005. - DOI - PubMed
    1. Bou R, Adán A, Borrás F, et al. Clinical management algorithm of uveitis associated with juvenile idiopathic arthritis: interdisciplinary panel consensus. Rheumatol Int. 2015;35:777–785. doi: 10.1007/s00296-015-3231-3. - DOI - PubMed
    1. Jinagal J, Gupta G, Agarwal A, et al. Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis. Indian J Ophthalmol. 2019;67:69. doi: 10.4103/ijo.IJO_417_19. - DOI - PMC - PubMed
    1. Kok H, Lau C, Maycock N, McCluskey P, Lightman S. Outcome of intravitreal triamcinolone in uveitis. Ophthalmology. 2005;112:1916.e1911–1916.e1917. doi: 10.1016/j.ophtha.2005.06.009. - DOI - PubMed
    1. Lowder C, Belfort R, Lightman S, et al. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol. 2011;129:545–553. doi: 10.1001/archophthalmol.2010.339. - DOI - PubMed

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