PMC7457411_01
Slit-lamp biomicroscopic photographs. At the age of 5 years and 6 months (A,
right eye; B, left eye) when oral methotrexate was started. At the age of 5
years and 8 months just before cataract surgery (C, right eye; D, left eye)
and 5 days after the surgery (E, right eye; F, left eye). At the age of 7
years (G, right eye; H, left eye), 1 year after the start of adalimumab.
Note that dense band keratopathy in both eyes (C, D) has been scaled off and
that inflammation has subsided in aphakic eyes (E, F).
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At the age of 5 years and 6 months (Figure 1A and B), oral methotrexate 10 mg/m2 (8 mg) weekly was initiated by the pediatrician for recurrent bilateral iridocyclitis in both eyes, and 2 months later (Figure 1C and D), he underwent posterior synechialysis, anterior capsulotomy, and lens cortex aspiration with a 25-gauge vitrectomy cutter under the irrigation with a 25-gauge irrigating cannula, both of which were inserted through 2 ports at the corneal limbus. Total posterior capsulectomy and core vitrectomy was done through the limbal side ports (Figure 1E and F).
Optical coherence tomography. At the age of 5 years of 11 months (A, right
eye; B, left eye), 1 month before the start of adalimumab. At the age of 6
years and 2 months (C, right eye; D, left eye), 2 months after the start of
adalimumab. At the age of 8 years and 1 month (E, right eye; F, left eye).
Note that macular edema in both eyes (A, B) has been resolved in 2 months
(C, D) after the start of adalimumab. Note also that ellipsoid zone at the
fovea (arrows in E, F), indicative of photoreceptor outer segments, is more
well visualized in the right eye (E) compared with the left eye (F),
explaining better visual acuity in the right eye.
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Postoperative visual acuity by correction with glasses (+14.75 diopters in the right eye and +14.25 diopters in the left eye on the focus of 50 cm from the eyes) remained at 0.04 in both eyes due to macular edema (Figure 2A and B) when he used oral methotrexate 10 mg in a week and topical 0.1% fluorometholone 4 times daily. In 2 months with scheduled injection of adalimumab, the macular retina was demonstrated to have normal structure by optical coherence tomography (Figure 2C and D). At the final visit at the age of 11 years and 6 months, he had the best-corrected visual acuity of 0.8 in the right eye and 0.4 in the left eye (Figure 2E and F), with adalimumab 40 mg every 2 weeks and methotrexate 8 mg in a week.