Pars plana vitrectomy versus immunomodulatory therapy for intermediate uveitis: a prospective, randomized pilot study.

PURPOSE: Comparison of pars plana vitrectomy (PPV) with immunomodulatory therapy (IMT) for patients with intermediate uveitis (IU). METHODS: A prospective, randomized pilot study was performed on patients with recalcitrant IU associated with degradation of visual acuity (VA) despite standard treatment. Outcome measures (VA, intraocular pressure, anterior chamber and vitreous cellular infiltrate) were collected. RESULTS: Sixteen patients (18 eyes) were randomized to the PPV IMT group. Nine of 11 eyes (82%) treated with PPV showed resolution of inflammation at follow-up, at 5.93 years. Four of 7 eyes (57%) given IMT had persistent inflammation requiring subsequent PPV. PPV patients showed greater improvement in Snellen line, IOP, and vitreous cell reduction. Three PPV patients had cystoid macular edema (CME) initially; all resolved postoperatively. CME improved in 2 of 3 eyes using IMT. CONCLUSIONS: A higher percentage of patients treated with PPV had improvement of uveitis compared to those given IMT. A multicentered clinical trial is needed to confirm and statistically validate these conclusions.

Intravitreal bevacizumab in refractory uveitic macular edema: one-year follow-up.

PURPOSE: Uveitis is a major cause of ocular morbidity in developed countries. It has been demonstrated that macular edema is a significant cause of decreased visual acuity and macular edema in these patients. In this article, we evaluate the long-term outcome of intravitreal bevacizumab in the treatment of refractory uveitic macular edema. METHODS: In this retrospective, noncomparative, interventional case series, uveitic patients with macular edema who were refractory to conventional therapy and who were treated with intravitreal bevacizumab were identified and assessed. Best-corrected visual acuity and optical coherence tomography central macular thickness measurements were collected and analyzed with correlative statistical analysis, including the use of Student paired t-test, Kaplan-Meier, and linear regression analysis. RESULTS: Twenty-nine eyes of 27 patients with diverse uveitic etiologies were analyzed and followed up at 1 year. Thirteen patients received a single intravitreal bevacizumab injection. Six patients required a second intravitreal bevacizumab injection, while 10 patients received combination therapy of intravitreal bevacizumab and triamcinolone acetonide. Baseline mean logMAR visual acuity was -0.59. At 1 year, the mean logMAR visual acuity was -0.42-/+ 0.36 (p=0.0045). Baseline mean central macular thickness was 383.66 microm. At 1 year, the mean thickness was 294.32-/+110.87 (p=0.0007). CONCLUSIONS: Intravitreal bevacizumab is a useful and therapeutically beneficial agent in the treatment of refractory uveitic macular edema. Some patients will require adjunctive intravitreal bevacizumab injections or the use of combination therapy with intravitreal triamcinolone acetonide.

Outcomes of cataract surgery in children with chronic uveitis.

PURPOSE: To evaluate the outcomes of cataract surgery in children with chronic uveitis. SETTING: Massachusetts Eye Research and Surgery Institution, Boston, Massachusetts, USA. METHODS: This retrospective chart review was of patients younger than 17 years with a history of uveitis who had cataract surgery before June 2004. RESULTS: Thirty-four children (41 eyes) were identified. The mean age of the 10 boys and 24 girls was 9.8 years (range 4 to 17 years) and the mean total follow-up, 4.1 years (range 0.3 to 15.7 years). Twenty-one children had juvenile idiopathic arthritis-associated uveitis, 7 had pars planitis, and 6 had other conditions. Sixteen patients had concomitant posterior segment pathology, 25 received perioperative immunomodulatory therapy, and 13 had intraocular lens (IOL) implantation. The postoperative best corrected visual acuity improved in 35 of 41 eyes; 31 eyes had an improvement of 3.6 lines at 1 year. Most patients (92%) improved after IOL implantation. Most patients (88%) who received immunomodulatory therapy attained better vision, but this was not statistically significant compared with those who did not (P = .47). Similarly, there was no statistically significant difference between those with posterior pathology and those without. At the end of the analysis (1 year), the cumulative probability of improvement in visual acuity in 41 eyes reached 0.91. CONCLUSION: In most cases, and with optimum control of intraocular inflammation, cataract surgery improved the visual outcome in children with chronic uveitis. Intraocular lens implantation was well tolerated in most cases, which may result in optimal vision.

Biological response modifier therapy for refractory childhood uveitis.

PURPOSE: To evaluate the use of biological response modifiers (BRM) in the treatment of refractory childhood uveitis. DESIGN: Retrospective non-comparative case series of pediatric patients with uveitis treated with BRM. PARTICIPANTS: 23 pediatric patients. METHODS: All children (18 years or younger) who received a BRM were assessed for visual changes, time to control inflammation, and any associated adverse side effects. Thirteen patients were treated with infliximab, five with adalimumab, and five with daclizumab. All patients had bilateral eye involvement. Diagnoses of the participants included juvenile idiopathic arthritis, keratouveitis, sarcoid panuveitis, Adamantiades-Behcets disease, and idiopathic panuveitis. MAIN OUTCOME MEASURES: Inflammation and visual acuity. RESULTS: In the infliximab group 16 of 26 eyes (62%), and 10 of 13 patients (77%) demonstrated an improvement in visual acuity. Twenty of 26 eyes (77%) demonstrated an improvement in the degree of inflammation. In the adalimumab group, four of 10 eyes (40%) demonstrated an improvement in visual acuity, with five of 10 eyes (50%) demonstrating an improvement in inflammation. Four of 10 eyes (40%) in the daclizumab group demonstrated an improvement in vision with eight of 10 eyes (80%) demonstrating an improvement in inflammation. CONCLUSION: BRM appear to be safe to use in children, and represent a useful therapeutic adjunctive drug group for treating recalcitrant childhood uveitis.