Ku Wei-Ning, Lin Chun-Ju, Tsai Yi-Yu
Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Taiwan J Ophthalmol. 2018 Jul-Sep;8(3):164-167. doi: 10.4103/tjo.tjo_63_17.
We report the rescue effects of adalimumab (HUMIRA) therapy in a case of refractory pediatric panuveitis complicated with steroid-induced glaucoma. A 13-year-old girl had suffered from blurred vision since January 2013. Bilateral idiopathic panuveitis with macular edema (ME) was diagnosed. She had previously been treated with systemic steroids, methotrexate, cyclosporine, and mycophenolate. All treatments had failed to suppress the ocular inflammation and ME persisted. Intravitreal dexamethasone implant injections were given to both eyes and ME subsided; however, complications with steroid-induced glaucoma and cataract occurred. ME also recurred following absorbance of the dexamethasone implant. After administration of subcutaneous adalimumab injections every 2 weeks, inflammatory activity was well controlled and ME subsided. Phacoemulsification and posterior intraocular lens implantation were performed in both eyes. Menorrhagia and anemia were noted 9 months after adalimumab treatment. Thereafter, adalimumab was reduced and her anemia improved. Her vision had remained 20/20 for 33 months. Refractory pediatric uveitis usually requires more aggressive treatment. Intraocular glucocorticoid releasing implant could be used to lessen the possible systemic side effects in children. Intravitreal dexamethasone implant was effective in treating the inflammatory ME but could be complicated with steroid glaucoma and cataract. Tumor necrosis factor-blocking agents have been used to treat chronic, refractory uveitis in adults as well as children. Adalimumab was a favorable biological agent in steroid-responding pediatric patient of refractory noninfectious uveitis but could be complicated with menorrhagia. Long-term follow-up and more cases are mandatory.
我们报告了阿达木单抗（修美乐）治疗一例难治性儿童全葡萄膜炎合并类固醇性青光眼的挽救效果。一名13岁女孩自2013年1月起视力模糊。诊断为双侧特发性全葡萄膜炎伴黄斑水肿（ME）。她此前曾接受全身类固醇、甲氨蝶呤、环孢素和霉酚酸酯治疗。所有治疗均未能抑制眼部炎症，ME持续存在。双眼均给予玻璃体内地塞米松植入注射，ME消退；然而，出现了类固醇性青光眼和白内障并发症。地塞米松植入物吸收后ME也复发。每2周皮下注射阿达木单抗后，炎症活动得到良好控制，ME消退。双眼均行超声乳化白内障吸除术及后房型人工晶状体植入术。阿达木单抗治疗9个月后出现月经过多和贫血。此后，减少了阿达木单抗的用量，她的贫血有所改善。她的视力在33个月内一直保持在20/20。难治性儿童葡萄膜炎通常需要更积极的治疗。眼内糖皮质激素缓释植入物可用于减轻儿童可能出现的全身副作用。玻璃体内地塞米松植入物对治疗炎症性ME有效，但可能并发类固醇性青光眼和白内障。肿瘤坏死因子阻断剂已用于治疗成人和儿童的慢性难治性葡萄膜炎。阿达木单抗是治疗难治性非感染性葡萄膜炎且对类固醇有反应的儿科患者的一种良好生物制剂，但可能并发月经过多。必须进行长期随访并纳入更多病例。
