Effect of a drug combination treatment on ocular perfusion in recurrent idiopathic intermediate uveitis.
OBJECTIVE
To test the effect of a drug combination therapy on ocular perfusion in human eyes affected by idiopathic intermediate uveitis.


METHODS
Seven patients (12 eyes) showing active signs of intermediate uveitis, with at least two more similar episodes reported within the previous 12 months, were enrolled in a prospective case series. Two fellow healthy eyes of two of the enrolled patients were studied as internal controls. Color Doppler imaging of the central retinal artery (CRA), the ophthalmic artery (OA), and the posterior ciliary arteries (PCAs) was performed at the time of enrollment, and at 6 and 12 months after starting treatment with oral fluorocortolone, cyclosporine, and parenteral methotrexate. The best-corrected visual acuity was concurrently measured as a second parameter.


RESULTS
In the 12 affected eyes, the mean visual acuity (+/-SD) improved from 0.15(+/-0.12) to 0.04(+/-0.18) LogMAR (paired samples Student's t-test: p = 0.015). The resistivity index (RI +/- SD) of the CRA decreased from 0.81(+/-0.13) to 0.71(+/-0.13)(p = 0.0091). Further, the variation of the RI in the PCAs reached a borderline significance (p = 0.062), decreasing from 0.71(+/-0.12) to 0.61(+/-0.12). No significant changes were observed in the OA. Moreover, eyes showing a visual improvement of > or =0.1 (LogMAR) were more likely to show a > or =10% improvement of the RI for the CRA (Fisher's exact test: p = 0.018; power = 90%; alpha probability = 5%; odds ratio = 2,4).


CONCLUSIONS
In eyes affected by idiopathic intermediate uveitis, treated with a systemic drug combination therapy, the improvement of the visual acuity seems to correlate with a proportional improvement of the retrobulbar circulation.
Cimino
Luca
L
Ocular Immunology and Immunopathology Center, Glaucoma Research and Care Center of University Eye Clinic, Community Hospital, Parma, Italy.
Finzi
Giuseppe
G
Mora
Paolo
P
Zavota
Laura
L
Gandolfi
Stefano A
SA
Orsoni
Jelka G
JG
D000328:Adult; D001783:Blood Flow Velocity; D019842:Ciliary Arteries / Q000502:physiology; D003348:Cortisone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005123:Eye / Q000098:blood supply*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D009880:Ophthalmic Artery / Q000502:physiology; D010477:Perfusion; D011446:Prospective Studies; D012008:Recurrence; D012039:Regional Blood Flow; D012161:Retinal Artery / Q000502:physiology; D018615:Ultrasonography, Doppler, Color; D015867:Uveitis, Intermediate / Q000188:drug therapy* / Q000503:physiopathology*; D014792:Visual Acuity
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; C033001:9-fluorocortisone; D016572:Cyclosporine; D003348:Cortisone; D008727:Methotrexate