Agarwal Aniruddha, Hassan Muhammad, Sepah Yasir J, Do Diana V, Nguyen Quan Dong
Ocular Imaging Research and Reading Center (OIRRC), Omaha, NE, 68198-5540, USA.
Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Am J Ophthalmol Case Rep. 2016 Sep 28;4:78-82. doi: 10.1016/j.ajoc.2016.09.004. eCollection 2016 Dec.
To describe the clinical course of a patient with non-infectious idiopathic unilateral panuveitis and retinal vasculitis treated with subcutaneous repository adrenocorticotropic hormone (ACTH) gel.
A 33-year-old male presented with blurry vision and floaters in the left eye (OS). The best-corrected visual acuity was 20/20 in the right eye (OD) and 20/50 in OS at the time of initial presentation. Slit-lamp examination revealed mild anterior segment inflammation in OS. There were 1 + vitreous haze and 2 + cells noted in OS. Clinical examination and ancillary imaging assessment including fluorescein angiography revealed retinal vasculitis and optic nerve head inflammation. After infectious etiologies were ruled out, the patient was started on oral corticosteroids and enrolled in a clinical trial employing intravenous tocilizumab therapy. Six months after completion of the tocilizumab trial, the patient demonstrated recurrence of disease. Twice weekly subcutaneous ACTH gel was initiated and the patient demonstrated improvement of retinal vascular inflammation.
Repository subcutaneous ACTH gel formulation may be a safe and viable therapeutic option for patients with non-infectious uveitis and retinal vasculitis. Clinical trials using this formulation in a larger patient cohort with longer monitoring are indicated to evaluate its tolerability and bioactivity.
描述一名患有非感染性特发性单侧全葡萄膜炎和视网膜血管炎的患者接受皮下注射长效促肾上腺皮质激素（ACTH）凝胶治疗的临床过程。
一名33岁男性出现左眼视物模糊和飞蚊症。初诊时右眼最佳矫正视力为20/20，左眼为20/50。裂隙灯检查发现左眼眼前节轻度炎症。左眼可见1+玻璃体混浊和2+细胞。临床检查及包括荧光素血管造影在内的辅助影像学评估显示视网膜血管炎和视神经乳头炎。排除感染性病因后，患者开始口服皮质类固醇，并参加了一项使用静脉注射托珠单抗治疗的临床试验。托珠单抗试验完成6个月后，患者疾病复发。开始每周两次皮下注射ACTH凝胶，患者视网膜血管炎症得到改善。
长效皮下注射ACTH凝胶制剂可能是治疗非感染性葡萄膜炎和视网膜血管炎患者的一种安全可行的治疗选择。建议在更大的患者队列中使用该制剂进行更长时间监测的临床试验，以评估其耐受性和生物活性。
