Intravitreal dexamethasone implant as an option for anti-inflammatory therapy of tuberculosis uveitis

Int Ophthalmol. 2019 Feb;39(2):485-490. doi: 10.1007/s10792-018-0831-4. Epub 2018 Jan 29.

Abstract

Introduction: Tuberculosis-associated uveitis remains a diagnostic and therapeutic challenge. After diagnosis of tuberculosis and initiation of anti-tuberculosis therapy for tuberculosis uveitis, the clinical responses are favorable. However, at 4-6 weeks of the therapy, there commonly occurs paradoxical deterioration due to an increase in inflammation which is often accompanied by cystoid macular edema. Thus, adjuvant administration of anti-inflammatory regimen should be considered. For this purpose, systemic and periocular steroids, systemic and intravitreal immunosuppressive agents have been tested. Nevertheless, there is no report in the literature about intravitreal dexamethasone slow-release implants for the treatment of this inflammatory condition.

Methods: Case presentation.

Results: We presented a tuberculosis uveitis case whose ocular inflammation is partially modified by systemic and periocular steroid injections and then well controlled by the intravitreal dexamethasone implant.

Conclusion: Intravitreal dexamethasone implant injection seems to be a safe and potent option for the treatment of macular edema secondary to tuberculosis uveitis.

Keywords: Dexamethasone implant; Granuloma; Infectious; Intravitreal; Jarisch–Herxheimer reaction; Posterior uveitis; Tuberculosis; Uveitis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antitubercular Agents / therapeutic use*
  • Dexamethasone / administration & dosage*
  • Drug Implants
  • Drug Therapy, Combination
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / drug therapy*
  • Female
  • Follow-Up Studies
  • Glucocorticoids / administration & dosage
  • Humans
  • Tomography, Optical Coherence
  • Tuberculosis, Ocular / diagnosis
  • Tuberculosis, Ocular / drug therapy*
  • Uveitis / diagnosis
  • Uveitis / drug therapy*
  • Visual Acuity

Substances

  • Antitubercular Agents
  • Drug Implants
  • Glucocorticoids
  • Dexamethasone