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Open Access Highly Accessed Brief report

Treatment of refractory uveitic macular edema with dexamethasone intravitreal implants in a pediatric patient with bilateral granulomatous idiopathic panuveitis: a case report

Serge Bourgault12*, Maryam Aroichane3, Leah A Wittenberg1, Andréane Lavallée12 and Patrick E Ma1

Author Affiliations

1 Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia V5Z 3N9, Canada

2 Département d’Ophtalmologie et ORL - Chirurgie cervico-faciale, Université Laval, Québec, Québec G1V 0A6, Canada

3 Department of Ophthalmology and Visual Sciences, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia V6H 3N1, Canada

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Journal of Ophthalmic Inflammation and Infection 2013, 3:61  doi:10.1186/1869-5760-3-61

Published: 22 October 2013

Abstract

Background

Macular edema is a common complication of uveitis and represents a therapeutic challenge, especially in children. Recently, intravitreal dexamethasone implants have been shown to decrease intraocular inflammation and to control uveitic macular edema in patients with non-infectious intermediate or posterior uveitis.

Findings

An 11-year-old boy with bilateral granulomatous idiopathic panuveitis and orbital inflammation experienced macular edema refractory to topical steroids and subcutaneous methotrexate. He was treated with off-label bilateral injections of dexamethasone intravitreal implant. Three months later, his vision had improved from 20/200 in both eyes to 20/30 in the right eye and 20/40 in the left eye. Optical coherence tomography showed complete resolution of the cystoid macular edema and subretinal fluid in both eyes.

Conclusions

This is a rare report of the use of bilateral dexamethasone intravitreal implant in a pediatric patient. The implants achieved complete resolution of the uveitic macular edema with no adverse events 3 months post-implantation.

Keywords:
Dexamethasone intravitreal implant; Ozurdex®; Cystoid macular edema; Uveitic macular edema; Uveitis; Panuveitis; Pediatric uveitis