Vision Science and Eye

Biography

Introduction: Uveitis is a leading cause of preventable blindness. It is responsible for 25% of blindness in the developing world and 30,000 new cases of blindness per year in the United States. 35% of all uveitis patients have visual impairment. As such, uveitis is a worldwide problem of significant proportions with peak onset during the wage-earning years (mean age at presentation of 40 years) which magnifies the socioeconomic impact of the disease. Furthermore, treatment of this disease in many cases involves the use of medications that are expensive and have significant systemic side effects. In this paper, we discuss the use of intraocular adalimumab for the treatment of vision threatening uveitis.

Methods: In a pilot study we investigated the safety and efficacy of intravitreal adalimumab (IVA) (1.5 mg/0.03 ml intravitreal injection every month) for the treatment of active uveitis as a de novo treatment and as a rescue therapy in patients on treatment with systemic adalimumab.

Results: 6/7 patients (12/13 eyes) completed 26 weeks of treatment. One patient (1 eye) failed treatment; 7/12 eyes had improvement of two ETDRS lines; 3/3 eyes had resolution of anterior chamber cells; 9/10 eyes with vitreous haze had zero haze at 26 weeks and 5/8 eyes with macular edema had complete resolution. Median fluorescein angiography score improved from 14 to 4 on last follow-up. Seven eyes of four patients with Behcet's panuveitis on systemic adalimumab therapy were treated for breakthrough attacks with IVA. 13 breakthrough attacks were documented over three years. The mean number of injections necessary for resolution of an attack was 2.4 over an average of 2.6 months. 3/13 attacks resolved after one injection.

Conclusion & Significance: Intravitreal adalimumab may be an effective, practical, safe and affordable adjunctive therapy for the control of de novo or breakthrough inflammation in select patients.

Abstract

Abstract : ¬¬¬¬Novel treatment for vision threatening uveitis