Abstract #80484 Published in IGR 20-3

Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab

Hiyama T; Harada Y; Kiuchi Y
American journal of ophthalmology case reports 2019; 14: 1-4

PURPOSE: Sympathetic ophthalmia (SO) is an autoimmune, bilateral, granulomatous panuveitis, which occurs following penetrating eye injury or eye surgery. We report two cases of refractory SO in patients with a history of trabeculectomy, which were treated effectively with adalimumab. OBSERVATIONS: Case 1: A 69-year-old male with a history of trabeculectomy for rubeotic glaucoma of the right eye, secondary to diabetic retinopathy 8 years prior, presented with a decrease in visual acuity of the left eye due to SO. After two rounds of pulse corticosteroid therapy (intravenous infusion of 1 g methylprednisolone/day for 3 days), serous retinal detachment (SRD) was resolved. As oral prednisolone was tapered to avoid deterioration of the diabetes mellitus, we shifted to other immunosuppressive therapies to control inflammation. Methotrexate 6mg/week (0.1 mg/kg) was introduced first, but was discontinued owing to side effects. After 6 months of cyclosporine 100 mg/day (1.5 mg/kg, max. dose 2.3 mg/kg), the SRD relapsed. Adalimumab was then introduced, which led to remission of SRD, and inflammation was controlled for 7 months.Case 2: A 43-year-old male, with a history of trabeculectomy for primary open-angle glaucoma of the right eye 4 years prior, presented with blurred vision in the right eye. Optical coherence tomography revealed SRD and choroidal thickening in both eyes. Pulse corticosteroid therapy (intravenous infusion of 1 g methylprednisolone/day for 3 days) was initiated, followed by oral prednisolone. SRD gradually improved, but it did not resolve completely. Given the severe visual loss the patient had experienced due to the primary open-angle glaucoma, oral prednisolone was tapered quickly to avoid steroid-induced intraocular pressure (IOP) elevation. Cyclosporine 125 mg/day (1.8 mg/kg, max. dose 2.1 mg/day) was introduced first, but was later discontinued because of side effects. Adalimumab was then administered, causing the SRD to disappear; and IOP was well-controlled. After the introduction of adalimumab, control of intraocular inflammation was achieved and IOP remained within the target range for 7 months. CONCLUSIONS AND IMPORTANCE: SO requires long-term immunosuppressive treatment. Adalimumab is an effective treatment in cases of steroid or immunosuppressant refractory SO, particularly for glaucoma patients, in whom long-term steroid therapy should be avoided.

Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan.

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9.4.6 Glaucomas associated with inflammation, uveitis (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
11.15 Other drugs in relation to glaucoma (Part of: 11 Medical treatment)

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