Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study

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Autor(a) principal: Shalaby,Osama
Data de Publicação: 2020
Outros Autores: Saeed,Ahmed, Elmohamady,Mohamed Nagy
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Arquivos brasileiros de oftalmologia (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492020000500402
Resumo: ABSTRACT Purpose: To compare the benefits and side effects of pars plana vitrectomy with those of systemic immune modulator therapy for patients with complicated intermediate uveitis. Methods: This prospective clinical trial enrolled patients with recurrent intermediate uveitis who exhibited minimal improvement of visual acuity, despite injections of periocular steroids. Twenty patients were randomized to the pars plana vitrectomy group or oral steroid and cyclosporine-A group (10 eyes of 10 patients per group). Follow-up was performed for 24 months to study changes in visual acuity, binocular indirect ophthalmoscopy score, fluorescein angiography, and optical coherence tomography findings. Results: Visual acuity (logarithm of the minimal angle of resolution) significantly improved from 0.71 to 0.42 (p=0.001) in the surgical group, whereas it improved from 0.68 to 0.43 (p=0.001) in the immune modulator therapy group. Seven patients (70%) in the surgical group gained ≥2 lines, and six patients (60%) in the immune modulator therapy group gained ≥2 lines (p=0.970). Fluorescein angiography and optical coherence tomography studies showed that six of seven pars plana vitrectomy patients who had cystoid macular edema experienced improvement, whereas two patients with diffuse macular edema did not experience improvement. In the immune modulator therapy group, three of six patients with cystoid macular edema did not experience improvement, whereas two patients with diffuse macular edema experienced improvement. Conclusions: Pars plana vitrectomy and immune modulator therapy resulted in significant improvement in visual function in patients with persistent inflammation secondary to chronic intermediate uveitis. Despite this success, there remains a need for the determination of optimal indications for the use of each modality. Immune modulator therapy was successful for the treatment of diffuse macular edema associated with chronic intermediate uveitis, whereas pars plana vitrectomy was not.
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spelling Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical studyIntermediate uveitisVitrectomyImmunomodulationMacular edemaABSTRACT Purpose: To compare the benefits and side effects of pars plana vitrectomy with those of systemic immune modulator therapy for patients with complicated intermediate uveitis. Methods: This prospective clinical trial enrolled patients with recurrent intermediate uveitis who exhibited minimal improvement of visual acuity, despite injections of periocular steroids. Twenty patients were randomized to the pars plana vitrectomy group or oral steroid and cyclosporine-A group (10 eyes of 10 patients per group). Follow-up was performed for 24 months to study changes in visual acuity, binocular indirect ophthalmoscopy score, fluorescein angiography, and optical coherence tomography findings. Results: Visual acuity (logarithm of the minimal angle of resolution) significantly improved from 0.71 to 0.42 (p=0.001) in the surgical group, whereas it improved from 0.68 to 0.43 (p=0.001) in the immune modulator therapy group. Seven patients (70%) in the surgical group gained ≥2 lines, and six patients (60%) in the immune modulator therapy group gained ≥2 lines (p=0.970). Fluorescein angiography and optical coherence tomography studies showed that six of seven pars plana vitrectomy patients who had cystoid macular edema experienced improvement, whereas two patients with diffuse macular edema did not experience improvement. In the immune modulator therapy group, three of six patients with cystoid macular edema did not experience improvement, whereas two patients with diffuse macular edema experienced improvement. Conclusions: Pars plana vitrectomy and immune modulator therapy resulted in significant improvement in visual function in patients with persistent inflammation secondary to chronic intermediate uveitis. Despite this success, there remains a need for the determination of optimal indications for the use of each modality. Immune modulator therapy was successful for the treatment of diffuse macular edema associated with chronic intermediate uveitis, whereas pars plana vitrectomy was not.Conselho Brasileiro de Oftalmologia2020-09-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492020000500402Arquivos Brasileiros de Oftalmologia v.83 n.5 2020reponame:Arquivos brasileiros de oftalmologia (Online)instname:Conselho Brasileiro de Oftalmologia (CBO)instacron:CBO10.5935/0004-2749.20200079info:eu-repo/semantics/openAccessShalaby,OsamaSaeed,AhmedElmohamady,Mohamed Nagyeng2020-10-13T00:00:00Zoai:scielo:S0004-27492020000500402Revistahttp://aboonline.org.br/https://old.scielo.br/oai/scielo-oai.phpaboonline@cbo.com.br||abo@cbo.com.br1678-29250004-2749opendoar:2020-10-13T00:00Arquivos brasileiros de oftalmologia (Online) - Conselho Brasileiro de Oftalmologia (CBO)false
dc.title.none.fl_str_mv Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study
title Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study
spellingShingle Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study
Shalaby,Osama
Intermediate uveitis
Vitrectomy
Immunomodulation
Macular edema
title_short Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study
title_full Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study
title_fullStr Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study
title_full_unstemmed Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study
title_sort Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study
author Shalaby,Osama
author_facet Shalaby,Osama
Saeed,Ahmed
Elmohamady,Mohamed Nagy
author_role author
author2 Saeed,Ahmed
Elmohamady,Mohamed Nagy
author2_role author
author
dc.contributor.author.fl_str_mv Shalaby,Osama
Saeed,Ahmed
Elmohamady,Mohamed Nagy
dc.subject.por.fl_str_mv Intermediate uveitis
Vitrectomy
Immunomodulation
Macular edema
topic Intermediate uveitis
Vitrectomy
Immunomodulation
Macular edema
description ABSTRACT Purpose: To compare the benefits and side effects of pars plana vitrectomy with those of systemic immune modulator therapy for patients with complicated intermediate uveitis. Methods: This prospective clinical trial enrolled patients with recurrent intermediate uveitis who exhibited minimal improvement of visual acuity, despite injections of periocular steroids. Twenty patients were randomized to the pars plana vitrectomy group or oral steroid and cyclosporine-A group (10 eyes of 10 patients per group). Follow-up was performed for 24 months to study changes in visual acuity, binocular indirect ophthalmoscopy score, fluorescein angiography, and optical coherence tomography findings. Results: Visual acuity (logarithm of the minimal angle of resolution) significantly improved from 0.71 to 0.42 (p=0.001) in the surgical group, whereas it improved from 0.68 to 0.43 (p=0.001) in the immune modulator therapy group. Seven patients (70%) in the surgical group gained ≥2 lines, and six patients (60%) in the immune modulator therapy group gained ≥2 lines (p=0.970). Fluorescein angiography and optical coherence tomography studies showed that six of seven pars plana vitrectomy patients who had cystoid macular edema experienced improvement, whereas two patients with diffuse macular edema did not experience improvement. In the immune modulator therapy group, three of six patients with cystoid macular edema did not experience improvement, whereas two patients with diffuse macular edema experienced improvement. Conclusions: Pars plana vitrectomy and immune modulator therapy resulted in significant improvement in visual function in patients with persistent inflammation secondary to chronic intermediate uveitis. Despite this success, there remains a need for the determination of optimal indications for the use of each modality. Immune modulator therapy was successful for the treatment of diffuse macular edema associated with chronic intermediate uveitis, whereas pars plana vitrectomy was not.
publishDate 2020
dc.date.none.fl_str_mv 2020-09-01
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dc.relation.none.fl_str_mv 10.5935/0004-2749.20200079
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dc.publisher.none.fl_str_mv Conselho Brasileiro de Oftalmologia
publisher.none.fl_str_mv Conselho Brasileiro de Oftalmologia
dc.source.none.fl_str_mv Arquivos Brasileiros de Oftalmologia v.83 n.5 2020
reponame:Arquivos brasileiros de oftalmologia (Online)
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