First Author: Y.Toklu TURKEY
Co Author(s): M. Arikan Yorgun E. Ensari Delibas
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Assessment of 0.7 mg dexamethasone (Ozurdex®) implantation combined with systemic immunosuppressive therapy in a case of sympathetic ophthalmia.
Yıldırım Beyazıt University, Ankara, Turkey
A 41-year-old man was admitted to our clinic with traumatic perforation of the right globe. He underwent a corneoscleral tear repair and then two vitreoretinal surgeries but it was seen that chorioretinal integrity wasn’t provided and the right eye was considered inoperable. The best corrected visual acuity (BCVA) was light perception in the right eye (RE) and 20/20 in the left eye (LE). By the third month after the trauma, he presented with blurred vision in the LE. The BCVA was 20/200 and on slit lamp examination, there were 3+ cells in the anterior chamber. Fundus examination showed moderate vitritis, macular edema and optic nerve swelling. Optical coherence tomography (OCT) revealed serous retinal detachment and intraretinal edema in the macula and optic nerve swelling. Intraocular pressure (IOP) was 14 mm Hg in both eyes. The patient was diagnosed with sympathetic ophthalmia. The treatment consisting of topical steroid every hour, siclopentolate three times a day and 1 mg/kg oral prednisolone per day were started. At the same time a single dose Ozurdex® implantation was performed.
1 week later, visual acuity improved and there were not inflammatory cells in the anterior chamber and the vitreous. In OCT, the fluid resorbed completely and macula appeared normal. 1 month later, visual acuity improved 20/20 and the optic disc swelling decreased. Oral prednisolone treatment was tapered. IOP was controlled with topical medications. The patient was examined monthly and all his ocular findings were stable both clinically and anatomically for five months. At that time, azathioprine was added for systemic therapy by rheumatology department. By the fifth month after the first attack, there was a recurrence. Ozurdex® implantation was performed and systemic corticosteroid dose was increased. 1 week later BCVA improved, anterior and posterior segment were quiet and OCT showed that the fluid on macula completely disappeared. Oral prednisolone dose was reduced slowly. 4 months later, second recurrence was seen in the patient who used oral prednisolone 8 mg/d and azathioprine at that time. As the recurrence was seen under this treatment, 3 mg/kg/d oral cyclosporine was started instead of azathioprine treatment and oral prednisolone dose was increased to 1 mg/kg/d. His ocular findings returned to normal. Oral prednisolon dose was reduced. We have not seen a recurrence for three months.
In sympathetic ophthalmia, the efficacy of treatment may increase by adding 0.7 mg intravitreal dexamethasone implantation to the systemic immunosuppressive therapy, especially in the acute phase of the disease.