Title

GOOD OUTCOME OF ANTI TNF ALPHA IN THE TREATMENT OF IDIOPATHIC RETINAL VASCULITIS

Introduction

A retinal vasculitis occur as a part of an ocular or systemic disease. Rarely, it may be isolated, idiopathic condition, but it may also present as a manifestation of an underlying disorder, associated with diverse etiologies as infective, auto-immune, inflammatory or neoplastic disorders. Despite the large pathological diversity among the etiologies of retinal vasculitis, the clinical manifestations of inflammatory changes are similar, which are based on three pillars: inflammation, ischemia and neovascularization. The symptons include painless blurring of vision, floaters, scotomas, metamorphopsia. The objective of this case report is to demonstrate the significant improvement of macular edema and consequently of visual acuity only with the use of anti TNF Alpha, in a patient with idiopathic vasculitis masked by chronic corticotherapy.

Methods

Retrospective analysis of medical records and imaging exams, associated with the literature review on the subject. The patient underwent 40 mg subcutaneous adalimumab every 14 days during the 120-day period (until the submission of this abstract), and was followed up weekly by ophthalmological examinations, as well as optical coherence tomography exam (OCT) monthly.

Results

At the beginning of treatment the patient had visual acuity of 20/200 in the right eye (RE) and 20/60 in the left eye (LE), and OCT showing 511 micron of macular thickness in RE and 685micron in LE. Adalimumab had a considerably rapid response with decreased macular thickness, with first results showing within a month. And after 120 days of treatment featuring a new OCT with decreased macular thickness to 245 micron RE and 275 micron LE, achieving improved visual acuity with better correction of 20/20 RE and 20/50 -2 in LE.

Discussion

Biological agents are an innovative approach treatment of noninfectious uveitis, being a strong therapeutic option for cases refractory to corticosteroids or other immunomodulators, but a challenge for its use is still its high cost.

Keywords

ADALIMUMAB, UVEITE, EDEMA MACULAR, BIOLOGICAL AGENTS, VASCULITE, IDIOPATICO, UVEITIS, IDIOPATHIC, OCT

Area

CLINICAL CASE

Authors

ANA PAULA BORTOLOTTO, MARCELO LUIS GEHLEN, GRACE KELLY PELICIONI DE CASTRO, BERNARDO ANTONIO NEGREIROS MOTA, MARCELLO DE QUADROS RIBEIRO, CARLOS AUGUSTO MOREIRA NETO, CARLOS AUGUSTO MOREIRA JUNIOR, CAROLINE CORDEL RINGVELSKI