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Abstract：
BACKGROUND: Treatment of juvenile idiopathic arthritis (JIA)-associated uveitis necessitates the use of long-term corticosteroids or immunosuppressive agents, each of which poses their own significant side effect profile. Initial treatment requires intensive topical glucocorticoids, with a step-up approach employing immunosuppressive agents for those cases with poor response or high-risk complications such as macular oedema. To date, there is minimal evidence to support a specific approach to such complicated subgroups. We present the first case to successfully employ the 0.19 mg fluocinolone acetonide implant (ILUVIEN®, Alimera Sciences, Hampshire, UK) as a novel device for prolonged intravitreal administration of disease-modifying agents for patients with JIA complicated by uveitis.
METHODS: This retrospective case report describes a 20-year old woman diagnosed with oligoarticular JIA complicated by chronic uveitis and associated cystoid macular oedema (CMO). Considering factors including the patient\'s non-compliance, age, lens status, non-steroid response, and good response to short-term intravitreal steroid therapy, the 0.19 mg fluocinolone acetonide intravitreal implant was deemed an appropriate step-up treatment option.
RESULTS: At 12-month follow-up, the left eye (OS) showed an improvement in visual acuity to 6/15 - 1 from 6/60 + 1 (0.42 from 0.98 logMAR) (pre-insertion) and a reduction in central retinal thickness (CRT) of 199 μm from 471 μm. The right eye (OD), treated 10 months later, showed an improvement in visual acuity to 6/7.5 from 6/24 - 1 (0.10 from 0.56 LogMAR) and a reduction in CRT of 327 μm 6 months after treatment.
CONCLUSIONS: In this case, the 0.19 mg fluocinolone acetonide implant provided safe and effective long-term treatment of JIA-associated uveitis and secondary CMO. This potentially offers an alternative approach to complex cases that show good response to short-term corticosteroid use.
METHODS: This retrospective case report describes a 20-year old woman diagnosed with oligoarticular JIA complicated by chronic uveitis and associated cystoid macular oedema (CMO). Considering factors including the patient\'s non-compliance, age, lens status, non-steroid response, and good response to short-term intravitreal steroid therapy, the 0.19 mg fluocinolone acetonide intravitreal implant was deemed an appropriate step-up treatment option.
RESULTS: At 12-month follow-up, the left eye (OS) showed an improvement in visual acuity to 6/15 - 1 from 6/60 + 1 (0.42 from 0.98 logMAR) (pre-insertion) and a reduction in central retinal thickness (CRT) of 199 μm from 471 μm. The right eye (OD), treated 10 months later, showed an improvement in visual acuity to 6/7.5 from 6/24 - 1 (0.10 from 0.56 LogMAR) and a reduction in CRT of 327 μm 6 months after treatment.
CONCLUSIONS: In this case, the 0.19 mg fluocinolone acetonide implant provided safe and effective long-term treatment of JIA-associated uveitis and secondary CMO. This potentially offers an alternative approach to complex cases that show good response to short-term corticosteroid use.
摘要：
背景：治疗幼年特发性关节炎（JIA）相关葡萄膜炎需要长期使用皮质类固醇或免疫抑制剂，每个都有自己重要的副作用。初始治疗需要强化外用糖皮质激素，对于反应差或高危并发症如黄斑水肿的病例，采用免疫抑制剂的方法。迄今为止,只有很少的证据支持对这种复杂的亚组采取特定的方法.我们提出了第一个成功使用0.19mg醋酸氟轻松植入物的案例（ILUNEN®，AlimeraSciences,汉普郡,UK）作为一种新颖的装置，用于JIA并发葡萄膜炎的患者玻璃体内长期施用疾病修饰剂。
方法：该回顾性病例报告描述了一名20岁女性，被诊断患有少关节JIA并伴有慢性葡萄膜炎和相关的囊样黄斑水肿（CMO）。考虑到包括患者不合规在内的因素，年龄,镜头状态,非类固醇反应，对短期玻璃体内类固醇治疗反应良好，0.19mg氟轻松玻璃体内植入剂被认为是一种合适的强化治疗选择.
结果：在12个月的随访中，左眼（OS）显示视力从6/601（从0.98logMAR为0.42）（插入前）改善至6/15-1，中央视网膜厚度（CRT）从471μm减少199μm。右眼(OD),治疗10个月后，显示视力从6/24-1提高到6/7.5（从0.56LogMAR为0.10），治疗后6个月CRT减少327μm。
结论：在这种情况下，0.19mg醋酸氟轻松植入物为JIA相关性葡萄膜炎和继发性CMO提供了安全有效的长期治疗.这可能为对短期皮质类固醇使用表现出良好反应的复杂病例提供替代方法。
方法：该回顾性病例报告描述了一名20岁女性，被诊断患有少关节JIA并伴有慢性葡萄膜炎和相关的囊样黄斑水肿（CMO）。考虑到包括患者不合规在内的因素，年龄,镜头状态,非类固醇反应，对短期玻璃体内类固醇治疗反应良好，0.19mg氟轻松玻璃体内植入剂被认为是一种合适的强化治疗选择.
结果：在12个月的随访中，左眼（OS）显示视力从6/601（从0.98logMAR为0.42）（插入前）改善至6/15-1，中央视网膜厚度（CRT）从471μm减少199μm。右眼(OD),治疗10个月后，显示视力从6/24-1提高到6/7.5（从0.56LogMAR为0.10），治疗后6个月CRT减少327μm。
结论：在这种情况下，0.19mg醋酸氟轻松植入物为JIA相关性葡萄膜炎和继发性CMO提供了安全有效的长期治疗.这可能为对短期皮质类固醇使用表现出良好反应的复杂病例提供替代方法。
