Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab
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: C...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-06-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993618301257 |
| _version_ | 1811232340485079040 |
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| author | Tomona Hiyama Yosuke Harada Yoshiaki Kiuchi |
| author_facet | Tomona Hiyama Yosuke Harada Yoshiaki Kiuchi |
| author_sort | Tomona Hiyama |
| collection | DOAJ |
| description | 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. Keywords: Adalimumab, Sympathetic ophthalmia, Uveitis, TNFα antagonist, Glaucoma |
| first_indexed | 2024-04-12T11:01:32Z |
| format | Article |
| id | doaj.art-b929a30f5e1947bb9550718518da923d |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-04-12T11:01:32Z |
| publishDate | 2019-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-b929a30f5e1947bb9550718518da923d2022-12-22T03:35:57ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362019-06-011414Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumabTomona Hiyama0Yosuke Harada1Yoshiaki Kiuchi2Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, JapanCorresponding author.; Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, JapanDepartment of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, JapanPurpose: 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. Keywords: Adalimumab, Sympathetic ophthalmia, Uveitis, TNFα antagonist, Glaucomahttp://www.sciencedirect.com/science/article/pii/S2451993618301257 |
| spellingShingle | Tomona Hiyama Yosuke Harada Yoshiaki Kiuchi Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab American Journal of Ophthalmology Case Reports |
| title | Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab |
| title_full | Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab |
| title_fullStr | Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab |
| title_full_unstemmed | Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab |
| title_short | Effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab |
| title_sort | effective treatment of refractory sympathetic ophthalmia with glaucoma using adalimumab |
| url | http://www.sciencedirect.com/science/article/pii/S2451993618301257 |
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