High-dose Intravenous Corticosteroids for Ocular Inflammatory Diseases

Abstract

Purpose: To evaluate the effectiveness and risk of complications of high-dose intravenous pulsed corticosteroids for noninfectious ocular inflammatory diseases.

Methods: Retrospective cohort study in which 104 eyes of 70 patients who received high-dose intravenous corticosteroids for treatment of active ocular inflammation were identified from five centers. The main outcome measures were control of inflammation and occurrence of ocular or systemic complications within 1 month after treatment.

Results: Within ≤1 month of starting treatment, 57% of eyes achieved complete control of inflammation (95% confidence interval (CI): 33–83%), improving to 82% when near-complete control was included (95% CI: 61–96%). Most eyes (85%; 95% CI: 70–95%) gained clinically significant improvement in anterior chamber inflammation. One patient developed a colon perforation during treatment. No other major complications were recorded.

Conclusions: Treatment of ocular inflammation with high-dose intravenous corticosteroids resulted in substantial clinical improvement for most cases within 1 month. Complications of therapy were infrequent.

Keywords::

• corticosteroids
• inflammation
• intravenous
• noninfectious
• uveitis

ACKNOWLEDGEMENTS

a) Funding/Support: This study was supported primarily by the National Eye Institute (Bethesda, MD) Grant EY014943 (Dr. Kempen). Additional support was provided by Research to Prevent Blindness (New York, NY) and the Paul and Evanina Mackall Foundation (New York, NY). Dr. Kempen is a Research to Prevent Blindness James S. Adams Special Scholar Award recipient. Dr. Jabs and Dr. Rosenbaum were Research to Prevent Blindness Senior Scientific Investigator Award recipients during the conduct of the study. Dr. Thorne is a Research to Prevent Blindness Harrington Special Scholar Award recipient. Dr. Levy-Clarke was previously supported by and Dr. Nussenblatt continues to be supported by intramural funds of the National Eye Institute. Dr. Suhler also received support from the Unites States Veterans’ Administration. None of the sponsors had any role in the design and conduct of the report; collection, management, analysis, and interpretation of the data; nor in the preparation, review, and approval of this paper.

b) Financial Disclosures:

• C. Stephen Foster: (O) Eyegate, (C, L) Allergan; (C, L) Bausch & Lomb; (C) Sirion; (L) Alcon; (L) Inspire; (L) Ista; (L) Centocor

• Douglas A. Jabs: (C) Abbot Laboratories; (C) Alcon; (C) Roche; (C) Genzyme Corporation; (C) Novartis; (C) Allergan; (C) GlaxoSmithKline; (C) Applied Genetic Technologies Corporation; (C) The Johns Hopkins Dana Center for Preventive Ophthalmology

• John H. Kempen: (C) Alcon; (C) Lux Biosciences; (C) Sanofi-Pasteur

• James Rosenbaum: (O) Amgen, (C) Abbott; (C) ESBATech, (C) Lux Biosciences, (C) Centocor, (C) Genentech.

• O = Equity Owner, C = Consultant/Advisor, L = Lecture Fees.

c) This research has been approved by the institutional review boards of all participating centers.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.