Systemic Corticosteroids Therapy in the Management of Acute Zonal Occult Outer Retinopathy

Abstract

Purpose. To report the efficacy of systemic steroid in treating acute zonal occult outer retinopathy (AZOOR). Methods. Retrospective study of 9 consecutive patients of AZOOR, who received systemic steroid therapy in Changhua Christian Hospital from 2005 to 2013, is presented. The duration of therapy was at least 3 months. Patients were evaluated with best corrected visual acuity (BCVA), optical coherence tomography (OCT), fluorescein angiography (FA), indocyanine green angiography (ICG), visual field test, and electroretinography (ERG). Results. At the initial visit, visual field defect was noted in all patients and impaired visual acuity was noted in 4 eyes. OCT examination revealed disrupted ellipsoid zone at the macular area in 8 eyes and outer nuclear layer (ONL) loss in 1 eye. At the end of follow-up, all patients had improvement of visual field. The 4 eyes with initial impaired visual acuity had BCVA recovering to 20/20. Follow-up OCT showed partial or complete recovery of the ellipsoid zone at the macular area in the 8 eyes with initial disrupted ellipsoid zone and stable condition in the eye with ONL loss. The mean follow-up duration was 47.11 ± 26.65 months. Conclusion. Visual improvement was achieved in most cases of recent onset AZOOR after systemic steroid treatment.

Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of vision improvement after intravitreal injection of Ozurdex

“…Various treatments have been attempted in patients with AZOOR, including systemic corticosteroids, [ 11 , 12 , 24 ] other systemic immunosuppressive agents, [ 4 , 25 ] and antimicrobial agents, [ 19 ] but their effects were not conclusive yet. Based on the proposed mechanisms of anti-retinal antibody, [ 20 – 22 ] AZOOR could be an autoimmune disease with anti-retinal antibody leakage from the disc margin with spread of immune substance under the retina.…”

“…Their final logMAR BCVA (0.16 ± 0.52) was significantly better than the pre-treatment value (0.56 ± 0.60) ( P = 0.007), and the mean MD at the final visit (−9.82 ± 10.74 dB) was significantly higher than the initial value (−13.66 ± 10.73 dB) ( P = 0.02). Chen [ 12 ] gave three patients intravenous pulse steroid therapy (methylprednisolone 1000 mg/day for 3 days) as the initial treatment followed by oral prednisolone with gradual tapering within 3 months, and prescribed another five patients oral prednisolone 1 mg/kg/day as the initial treatment with gradual tapering in 3 months. Although all of the patients had improvement of visual field eventually; however, recurrence was noted in two patients and three patients experienced deterioration of the visual field after stopping or tapering the systemic steroid.…”

“…Although all of the patients had improvement of visual field eventually; however, recurrence was noted in two patients and three patients experienced deterioration of the visual field after stopping or tapering the systemic steroid. Immunotherapy with azathioprine [ 24 ] or mycophenolate [ 12 ] was added to patients with reactivation of the disease during prednisolone taper.…”

“…The efficacy of systemic steroids in treating AZOOR has been previously described. Visual improvement was achieved in most reported cases [ 11 , 12 ]. Herein, we present a patient whose symptoms did not subside with oral steroid use; however, he experienced visual improvement after receiving intravitreal injection of a sustained-released steroid.…”

Bilateral acute zonal occult outer retinopathy (AZOOR) in a young adult Indian male

“…It is mostly seen in young women and can be unilateral or bilateral. PubMed search revealed only one previous case report from India [ 4 ] and 4 relevant reports using keywords (AZOOR) (corticosteroids) [ 5 ], [ 6 ], [ 7 ], [ 8 ]. Hereby, we present a case of a 31-year-old Asian Indian male with bilateral presentation and treated with systemic steroids.…”