OCT guides management in uveitis clinic

Issue: February 25, 2016

WAIKOLOA, Hawaii — OCT has revolutionized how uveitic patients with cystoid macular edema are treated, according to Thomas A. Albini, MD, who related “Tips from the uveitis clinic” for his colleagues at Retina 2016.

“I get a lot of OCTs in the uveitis clinic. Any patient who doesn’t have 20/20 vision, I’m suspicious of uveitic cystoid macular edema, which is the driving force behind vision loss in a lot of uveitis entities. I want to be aware of whether they do have macular edema; it does change my treatment and how aggressive I am toward the posterior segment,” Albini said.

Thomas A. Albini

Even in anterior uveitis cases, Albini said that, when vision is not 20/20, “I get an OCT to look.”

The OCT gives objective data of improvement. In particular, in pediatric cases, serial OCT is better than a detailed contact exam to look for cystoid macular edema (CME), he said.

In his tips for treatment, Albini said the best cases to use local therapy, such as the Retisert implant (fluocinolone acetonide intravitreal implant 0.59 mg, Bausch + Lomb), as supported by the MUST trial, are in patients who are intolerant of systemic treatment, in patients with complicated immunosuppressive therapy or with unilateral disease, in patients who are pseudophakic and have undergone glaucoma surgery, and in patients with CME.

Best cases for systemic treatment are children without cataract, patients with existing glaucoma, patients who are well controlled on single-agent immunosuppression, patients with systemic disease, possible infectious etiology or poor compliance, and in patients with no response to intravitreal steroids.

“If intravitreal steroids aren’t going to work, then Retisert’s probably not going to work,” he said. – by Patricia Nale, ELS

Reference:

Albini TA. Tips from the uveitis clinic. Presented at: Retina 2016; Jan. 18-22, 2016; Waikoloa, Hawaii.

Disclosure: Albini reports financial relationships with Allergan and Bausch + Lomb.