Treatment of refractory uveitic macular edema with dexamethasone intravitreal implants in a pediatric patient with bilateral granulomatous idiopathic panuveitis: a case report

Serge Bourgault,Patrick E Ma,Maryam Aroichane,Andréane Lavallée,Leah A Wittenberg

doi:10.1186/1869-5760-3-61

Abstract

BackgroundMacular edema is a common complication of uveitis and represents a therapeutic challenge, especially in children. Recently, intravitreal dexamethasone implants have been shown to decrease intraocular inflammation and to control uveitic macular edema in patients with non-infectious intermediate or posterior uveitis.FindingsAn 11-year-old boy with bilateral granulomatous idiopathic panuveitis and orbital inflammation experienced macular edema refractory to topical steroids and subcutaneous methotrexate. He was treated with off-label bilateral injections of dexamethasone intravitreal implant. Three months later, his vision had improved from 20/200 in both eyes to 20/30 in the right eye and 20/40 in the left eye. Optical coherence tomography showed complete resolution of the cystoid macular edema and subretinal fluid in both eyes.ConclusionsThis is a rare report of the use of bilateral dexamethasone intravitreal implant in a pediatric patient. The implants achieved complete resolution of the uveitic macular edema with no adverse events 3 months post-implantation.

Highlights

Macular edema is a common complication of uveitis and represents a therapeutic challenge, especially in children
This is a rare report of the use of bilateral dexamethasone intravitreal implant in a pediatric patient
The prevalence of pediatric cases within the general uveitis population is estimated to range from 5% to 13.8% [1-3]

Summary

Introduction

Macular edema is a common complication of uveitis and represents a therapeutic challenge, especially in children. Intravitreal triamcinolone has been used to treat uveitic macular edema but is associated with a significant risk of increased intraocular pressure and cataract [8,9]. A novel dexamethasone intravitreal implant (Ozurdex®, Allergan Inc., Irvine, CA, USA) has been shown to significantly improve intraocular inflammation, visual acuity, and central macular thickness in adults with non-infectious intermediate or posterior uveitis [10].

Results

Conclusion