Vegas-Revenga Nuria, Martín-Varillas José Luis, Calvo-Río Vanesa, González-Mazón Iñigo, Sánchez-Bilbao Lara, Beltrán Emma, Fonollosa Alejandro, Maíz Olga, Blanco Ana, Cordero-Coma Miguel, Ortego Norberto, Torre Ignacio, Francisco Hernández Félix, Muñoz-Fernández Santiago, Esteban Ortega María Mar, Diaz-Llopis Manuel, Cañal Joaquin, Ventosa Juan Antonio, Demetrio-Pablo Rosalía, Agudo-Bilbao Mario, Domínguez-Casas Lucia, Hernández José Luis, Castañeda Santos, González-Gay Miguel A, Blanco Ricardo
Rheumatology, Hospital Galdakao-Usansolo, Galdakao, Spain.
Rheumatology, Hospital de Sierrallana, Torrelavega, Spain.
Clin Exp Rheumatol. 2022 Jan;40(1):142-149. doi: 10.55563/clinexprheumatol/imrgo2. Epub 2021 Mar 5.
Rapid control of intraocular inflammation in non-infectious uveitis (NIU) is mandatory to avoid irreversible structural and functional damage. In this study, we assessed the efficacy and safety of intravenous methylprednisolone (IVMP) pulses in the treatment of NIU.
A retrospective case series of 112 patients who received IVMP for the treatment of NIU, either isolated or associated with different underlying diseases, was studied. Intraocular inflammation (anterior chamber cells and vitritis) was the primary outcome measure. Secondary outcome measures were macular thickness and best corrected visual acuity (BCVA). Patients were assessed at baseline visit, and at days 2-5, 7, 15 and 30 after initiation of IVMP pulse therapy.
A total of 112 patients (mean age 42±14.5 yrs) were assessed. An underlying immune-mediated disease was diagnosed in 73 patients. Inflammatory ocular patterns were panuveitis (n=68), posterior uveitis (n=30), anterior uveitis (AU) (n=12), and intermediate uveitis (n=2). Additionally, patients presented cystoid macular oedema (CME) (n=50), retinal vasculitis (n=37), and exudative retinal detachment (n=31). Therapies used before IVMP included intraocular glucocorticoids (n=4), high-dose oral systemic glucocorticoids (n=77), and conventional (n=107) or biologic (n=40) immunosuppressive drugs. IVMP dose ranged from 80 to 1,000 mg/day for 3-5 consecutive days. Improvement was observed in AU, vitritis, BCVA, CME, and retinal vasculitis. At first month evaluation, total remission was achieved in 19 patients. Side effects of IVMP were respiratory infections (n=3), uncontrolled hyperglycaemia (n=1), herpes zoster (n=1), and oral candidiasis (n=1).
IVMP pulse therapy was effective and safe, and achieved rapid control of NIU.
快速控制非感染性葡萄膜炎（NIU）的眼内炎症对于避免不可逆的结构和功能损害至关重要。在本研究中，我们评估了静脉注射甲泼尼龙（IVMP）脉冲疗法治疗NIU的疗效和安全性。
对112例接受IVMP治疗NIU的患者进行回顾性病例系列研究，这些患者要么是单纯性NIU，要么合并不同的基础疾病。眼内炎症（前房细胞和玻璃体炎）是主要观察指标。次要观察指标为黄斑厚度和最佳矫正视力（BCVA）。在基线访视时以及IVMP脉冲治疗开始后的第2 - 5天、第7天、第15天和第30天对患者进行评估。
共评估了112例患者（平均年龄42±14.5岁）。73例患者被诊断患有潜在的免疫介导疾病。炎症性眼部模式包括全葡萄膜炎（n = 68）、后葡萄膜炎（n = 30）、前葡萄膜炎（AU）（n = 12）和中间葡萄膜炎（n = 2）。此外，患者还出现了黄斑囊样水肿（CME）（n = 50）、视网膜血管炎（n = 37）和渗出性视网膜脱离（n = 31）。IVMP治疗前使用的治疗方法包括眼内糖皮质激素（n = 4）、高剂量口服全身性糖皮质激素（n = 77）以及传统（n = 107）或生物（n = 40）免疫抑制药物。IVMP剂量为80至1000毫克/天，连续使用3 - 5天。在AU、玻璃体炎、BCVA、CME和视网膜血管炎方面观察到改善。在第一个月评估时，19例患者实现了完全缓解。IVMP的副作用包括呼吸道感染（n = 3）、血糖控制不佳（n = 1）、带状疱疹（n = 1）和口腔念珠菌病（n = 1）。
IVMP脉冲疗法有效且安全，可快速控制NIU。
