First Author: G.Karagiannidis-Stampoulis GREECE
Co Author(s): E. Kanonidou D. Balatsoukas
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To present a case with anterior and posterior uveitis, in which there were difficulties in diagnosis and treatment.
Department of Ophthalmology, Hippokrateion General Hospital of Thessaloniki, Thessaloniki, Greece.
A 70 years old patient, with ocular hypertension under treatment with prostaglandin analogue and history of psoriatic arthritis, presented to our department reporting progressive visual acuity (VA) reduction to the right eye during the past six months. VA was 4/10 for the right eye (OD) and 9/10 for the left eye (OS), intraocular pressure was 10mmHg for both eyes, there was bilateral anterior chamber (AC) reaction (Tyndal+) and optical coherence tomography (OCT) showed cystic macular edema with photoreceptors detachment and epiretinal membrane to the OD. Topical treatment with dexamethasone was applied, but one week later at the follow-up there was VA reduction to the OS as well (3/10 on both eyes), increased AC reaction (Tyndall++ on both eyes), bilateral mild scleritis, vitritis and macular edema.
The patient’s hospitalization was decided, to investigate the uveitis. Eye drops of ciprofloxacin, dexamethasone and cyclopentolate were administered, as well as prednisolone per os and glaucoma treatment switched to brimonidine. The patient was referred to a pathologist and rheumatologist and positive mantoux test was found. After two weeks of treatment, inflammation at the AC and vitreous had subsided, however, VA remained at 3/10 for the OD and 6/10 for the OS, while a new OCT showed intraand subretinal fluid in both eyes. Intravitreal injection of dexamethasone implant in the OD was performed. Three weeks later, on the second follow-up, VA was 9/10 for the OD and 10/10 for the OS, while OCT showed full recession of macular edema.
Investigation of uveitis may lead to diagnostic dilemmas, since the cause is not always clear. In some cases, intravitreal drug administration is necessary, in order to achieve adequate concentration in the eye.