Department of Ophthalmology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland.
Acta Ophthalmol. 2018 Sep;96(6):648-651. doi: 10.1111/aos.13744. Epub 2018 Apr 14.
We describe eight patients with juvenile idiopathic arthritis-related chronic uveitis, who received a fluocinolone acetonide implant (FAI, Retisert®, Bausch&Lomb) in one eye. All patients had poor visual acuity (VA) due to persistent macular oedema in one or both eyes despite treatment with antirheumatic medication.
Median age of the patients was 22.9 years (range, 14.1-39.7) and duration of uveitis 13.0 years (range, 6.8-28.4) at FAI implantation. Median preoperative best-corrected visual acuity (BCVA) was 0.1 (range, 0.05-0.4) and Standardization of Uveitis Nomenclature, SUN-grade was SUN 2+ (range, 0.5-4.0). All patients had been treated extensively with systemic corticosteroids and antirheumatic drugs by the time of FAI implantation. The median follow-up time was 5.3 years (range, 4.4-6.3).
Macular edema resolved in a median time of 0.2 years (range, 0.04-0.39) after the FAI implantation. The median BCVA was 0.5-0.63 (range, 0.1-1.0) from 1 to 5 years of follow-up. Macular edema did not recur in 5 eyes after the implantation. In three eyes, the macular oedema relapsed at 2.7, 2.9 and 5.5 years of follow-up. All our patients needed antirheumatic drugs in addition to the FAI to treat their macular edema. During the follow-up, 7 eyes required further intraocular operations: 4 cataract operations, 4 intraocular pressure -lowering operations and 1 retinal detachment surgery were performed.
Fluocinolone acetonide implant is a valuable option in the treatment of persistent macular edema associated with JIA-related uveitis refractory to systemic treatments.
我们描述了 8 例患有幼年特发性关节炎相关慢性葡萄膜炎的患者，他们在一只眼中接受了氟轻松醋酸酯植入物（FAI，Retisert®，Bausch&Lomb）治疗。所有患者均因一只或两只眼存在持续性黄斑水肿而导致视力不佳（VA），尽管已接受抗风湿药物治疗。
患者的中位年龄为 22.9 岁（范围 14.1-39.7），在 FAI 植入时葡萄膜炎的持续时间为 13.0 年（范围 6.8-28.4）。术前最佳矫正视力（BCVA）的中位数为 0.1（范围 0.05-0.4），葡萄膜炎命名标准化（SUN）分级为 SUN 2+（范围 0.5-4.0）。在接受 FAI 植入之前，所有患者均已广泛接受全身性皮质类固醇和抗风湿药物治疗。中位随访时间为 5.3 年（范围 4.4-6.3）。
在 FAI 植入后，黄斑水肿中位时间在 0.2 年内（范围 0.04-0.39）得到缓解。在 1 至 5 年的随访中，BCVA 的中位数为 0.5-0.63（范围 0.1-1.0）。在植入物植入后，5 只眼的黄斑水肿未再复发。在 3 只眼中，黄斑水肿在植入后 2.7、2.9 和 5.5 年时复发。为治疗黄斑水肿，我们所有患者均需要在 FAI 之外还使用抗风湿药物。在随访期间，7 只眼需要进一步进行眼内手术：4 只白内障手术、4 只眼压降低手术和 1 只视网膜脱离手术。
氟轻松醋酸酯植入物是治疗幼年特发性关节炎相关葡萄膜炎相关持续性黄斑水肿的一种有价值的选择，对于对抗风湿治疗无效的病例尤其如此。
