Absolute and long-lasting control of ocular, and possibly systemic, inflammation predisposes uveitis patients to satisfactory results after cataract extraction and intraocular lens implantation. Despite a lower rate of recurrences following oral steroid supplementation, the efficacy of an intensive perioperative topical steroid regimen alone in preventing postoperative uveitis relapse was statistically comparable. Secondary outcomes were also comparable between the two groups. Transient IOP elevation should be expected until treatment discontinuation.
Although not all the criteria for the diagnosis were fulfilled, clinical findings were compatible with BDUMP. The presence of scleral pigmented lesions and the good visual prognosis may widen the spectrum of this rare disease.
Purpose To describe a case of bilateral Idiopathic Retinitis,Vasculitis,Aneurysms and Neuroretinitis(IRVAN)successfully treated with systemic immunomodulatory treatment including steroid, cyclosporine and methotrexate.
Methods A 47‐year‐old Italian woman was diagnosed with IRVAN at our Service.She underwent extensive general and laboratory evaluation.Periodical ophthalmologic evaluations included best correct visual acuity(BCVA)assessment,slit lamp and fundus examination.Ocular alterations were documented by fluorescein and green indocyanine angiogram,and optical coherence tomography.
Results At her first examination BCVA was 20/32 in the right eye(RE)and 20/40 in the left eye(LE).In both eyes angiography showed retinal vasculitis with arterial aneurysms and moderate ischemia,mild papillitis and macular oedema.The patient started a systemic steroid spearing immunomodulatory treatment.After 12 months of follow‐up BCVA was 20/25 in the RE and 20/20 in the LE.Imaging showed a complete resolution of the retinal and optic nerve head active inflammation in both eyes,with significant reduction of macular oedema.
Conclusion IRVAN is an isolated retinal vascular disease that can progress to severe visual loss due to ischemic sequelae.Ocular inflammation is likely related to immunitary disregulation,even if the aetiology is still not clear.In the presented case the bilateral involvement with papillitis and the progression of the visual loss in spite of previous local and systemic steroid regimen, were the reasons that convinced us to propose a systemic immunomodulatory treatment.This treatment was well tolerated, with a complete resolution after one year of follow‐up.
Congenital syphilitic keratitis is usually treated with topical steroids and cycloplegic drugs, which not only can be ineffective but can also lead to complications such as cataract and glaucoma. In the present case report, a pediatric patient affected by syphilitic interstitial keratitis was treated successfully with an immunosuppressive drug combination therapy.
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