The rescue effect of adalimumab in the treatment of refractory pediatric panuveitis complicated with steroid-induced glaucoma

We report the rescue effects of adalimumab (HUMIRA(®)) therapy in a case of refractory pediatric panuveitis complicated with steroid-induced glaucoma. A 13-year-old girl had suffered from blurred vision since January 2013. Bilateral idiopathic panuveitis with macular edema (ME) was diagnosed. She had previously been treated with systemic steroids, methotrexate, cyclosporine, and mycophenolate. All treatments had failed to suppress the ocular inflammation and ME persisted. Intravitreal dexamethasone implant injections were given to both eyes and ME subsided; however, complications with steroid-induced glaucoma and cataract occurred. ME also recurred following absorbance of the dexamethasone implant. After administration of subcutaneous adalimumab injections every 2 weeks, inflammatory activity was well controlled and ME subsided. Phacoemulsification and posterior intraocular lens implantation were performed in both eyes. Menorrhagia and anemia were noted 9 months after adalimumab treatment. Thereafter, adalimumab was reduced and her anemia improved. Her vision had remained 20/20 for 33 months. Refractory pediatric uveitis usually requires more aggressive treatment. Intraocular glucocorticoid releasing implant could be used to lessen the possible systemic side effects in children. Intravitreal dexamethasone implant was effective in treating the inflammatory ME but could be complicated with steroid glaucoma and cataract. Tumor necrosis factor-blocking agents have been used to treat chronic, refractory uveitis in adults as well as children. Adalimumab was a favorable biological agent in steroid-responding pediatric patient of refractory noninfectious uveitis but could be complicated with menorrhagia. Long-term follow-up and more cases are mandatory.