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Cystoid macular oedema (CMO) is the most common sight-threatening complication of uveitis.1 High-dose oral corticosteroids, orbital floor steroid injections or intraocular steroid injections are commonly used in the initial management of CMO, however, early resolution of CMO and restoration of visual acuity can be variable. Although intravenous ‘pulse’ corticosteroid therapy has been used in the past to treat severe ocular inflammation, it is not commonly used in the context of uveitic CMO. However, since 2001, intravenous pulsed methylprednisolone has been used as a ‘rescue’ therapy for sight-threatening CMO due to intraocular inflammation at the Ocular Inflammatory Disease Clinic of Aberdeen Royal Infirmary with considerable effect. A search across Medline, EMBASE and the Cochrane Register revealed no studies reporting the use of intravenous pulsed methylprednisolone in the immediate management of uncontrolled uveitic CMO. We therefore present the results of a recently treated cohort of patients with the aim of demonstrating the efficacy and safety of intravenous ‘pulse’ methylprednisolone for the treatment of uveitic CMO.
Fourteen eyes (11 patients) presenting consecutively with persistent CMO due to intraocular inflammation were recruited. Of these, eight out of 11 patients (10/14 eyes) were uncontrolled on existing corticosteroid or immunosuppressant therapy. All patients were treated with intravenous pulsed methylprednisolone, given as 1 g/day for 3 days followed by a rapid tapering dose of oral steroids. The primary outcome measure was a reduction in central macular thickness (CMT) on optical coherence tomography (OCT). Secondary outcomes included pinhole visual acuity (PHVA) and documentation of side effects or complications of therapy. PHVA was measured on a Snellen chart at 6 m and converted to the LogMAR equivalent to allow accurate statistical analysis. A mixed-model analysis of variance …