Clinical Outcomes of Adjunctive Sustained-Release Intravitreal Dexamethasone Implants in Tuberculosis-Associated Multifocal Serpigenoid Choroiditis

Ocul Immunol Inflamm. 2018;26(6):877-883. doi: 10.1080/09273948.2017.1383446. Epub 2017 Oct 11.

Abstract

Purpose: To analyze the safety and efficacy of sustained-release intravitreal dexamethasone implant (Ozurdex) in management of TB-associated multifocal serpiginoid choroiditis (MSC).

Methods: Retrospective review of TB-associated MSC patients, treated with anti-TB therapy (ATT) and adjunctive intravitreal Ozurdex.

Results: Nine eyes of six patients were included. Four patients required Ozurdex implant for progressive or new lesions following ATT and two for additional systemic contraindications to corticosteroids - hyperglycemia and uncontrolled hypertension, respectively. The mean time to resolution was 9.17 ± 7.71 weeks. The mean follow-up post-injection was 13.11 ± 6.05 months (median 12 months [range 6-24.5 months]). Only one of nine eyes developed recurrent MSC lesions and this was attributed to possible autoimmune etiology. Two eyes (22.2%) developed steroid-induced glaucoma - one required implant removal.

Conclusions: Sustained-release intravitreal dexamethasone is a safe and efficacious adjunctive anti-inflammatory therapy for TB-associated MSC patients with contraindication for systemic corticosteroids or requiring supplemental anti-inflammatory therapy.

Keywords: Dexamethasone; intravitreal; serpigenoid; sustained-release; tuberculosis; uveitis.

MeSH terms

  • Adult
  • Choroiditis / diagnosis
  • Choroiditis / drug therapy*
  • Choroiditis / etiology
  • Delayed-Action Preparations
  • Dexamethasone / administration & dosage*
  • Drug Implants
  • Female
  • Fluorescein Angiography
  • Follow-Up Studies
  • Fundus Oculi
  • Glucocorticoids / administration & dosage
  • Humans
  • Intravitreal Injections
  • Male
  • Microscopy, Acoustic
  • Middle Aged
  • Multifocal Choroiditis
  • Ophthalmoscopy
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Tuberculosis, Ocular / complications*
  • Young Adult

Substances

  • Delayed-Action Preparations
  • Drug Implants
  • Glucocorticoids
  • Dexamethasone

Supplementary concepts

  • Multifocal choroiditis