Optimization of corticosteroid therapy for uveitis complicated with macular edema

Aim. To develop a therapeutic strategy for uveitis complicated with macular edema (ME) based on topical corticosteroids (CS), including sub-Tenon’s administration of CS with subsequent intravitreal injection an Ozurdex implant.

Methods. The examination of 32 patients with chronic recurrent uveitis complicated with ME revealed a correlation between uveitis and the presence of systemic diseases (ankylosing spondylitis, rheumatoid arthritis, etc.). The patients were divided into two groups depending on the selected treatment after completion of the sub-Tenon’s administration of dexamethasone: 1st group – 17 patients with Ozurdex intravitreal implants; 2nd group – 15 patients receiving only dexamethasone instillations. Ophthalmological examination was carried out using optical coherence tomography and microperimetry. The markers of eye inflammation included the total clinical inflammation index and C-reactive protein (CRP) levels in lacrimal fluid (LF). The patients were examined prior to treatment as well as 10 days, 1, 3, 6, and 12 months after the completion of CS therapy. The control comprised functionalmorphological and laboratory parameters of 10 healthy people.

Results. The main intragroup differences were observed one month after the onset of treatment. Patients in the 1st group demonstrated the disappearance of clinical symptoms of uveal inflammation, with the CRP level in LF returning to normal (5.3 ± 0.07 mg/ml) values and differing insignificantly from the control. In these patients, the largest increase in functional parameters compared to the baseline was recorded, with the best corrected visual acuity (BCVA) and eye illumination sensitivity growing by 0.59 and 5.8 dB, respectively. Patients in the 2nd group demonstrated the persistence of some clinical symptoms of uveal inflammation. In these patients, optimal functional and morphological results were achieved three months after the onset of treatment. These results were not only inferior to those obtained in the 1st group, but also proved unstable over longer follow-up periods (6–12 months).

Conclusions. The developed optimized approach of CS therapy for uveitis complicated with ME confirmed its high clinical efficacy: a 3-fold reduction in the duration of uveal inflammation symptoms, a 1.25-fold increase in the frequency of complete ME resorption with the restoration of normal retinal topography in the macula, as well as a 2.2- and 2.35-fold increase in BCVA and eye illumination sensitivity, respectively. 

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