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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 …
Contributors All authors were involved in the conception and design of the study. SYK designed data collection tools and collected the data in Aberdeen and in Singapore, analysed the data and contributed to the writing up of the results. LK was the primary investigator in Aberdeen Royal Infirmary; she was involved in the recruitment of patients and oversaw data collection in Aberdeen. She is the corresponding author. SPC was the primary investigator in Singapore National Eye Centre; she was involved in the recruitment of patients and collection of data at this site. JVF was the supervising author and was involved in conception, design and data analysis. All authors were involved in editing and revising the draft paper, and approval of the final paper was obtained from all authors.
Competing interests None.
Ethics approval Intravenous pulsed methylprednisolone is used as the standard of care in patients with uveitic CMO in Aberdeen Royal Infirmary, and has been used in this manner since 2001. Many patients have been successfully treated in this way. As such, this is not a prospective study but merely documents a recent cohort of patients treated as part of the standard protocol of treatment used by the unit to control intraocular inflammation. The objective in reporting this material was to draw attention to the effectiveness of this treatment, since it was realised that few units adopt this practice, but rather use oral or periocular/intraocular steroid treatments which we have found are less rapid and effective in their control of the inflammation. Since this report is, in effect, an audit of clinical practice rather than a prospective study, there was no IRB review. As part of good clinical practice, all patients were fully informed of the options and risks of therapy, and as such, the recruitment and consent process, data collection and reporting of this study have all been performed according to the ethical principles underlying the Declaration of Helsinki and the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Good Clinical Practice guidelines, with the well-being and best interests of each patient taking priority at all times.
Provenance and peer review Not commissioned; externally peer reviewed.