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Alexander Barnes, Angela Bessette, Careen Y Lowder, Sunil K Srivastava; Treatment of Acute Zonal Occult Outer Retinopathy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1879.
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© 2017 Association for Research in Vision and Ophthalmology.
To report on the use of systemic and intravitreal steroids as part of the treatment for acute zonal occult outer retinopathy (AZOOR).
Retrospective, interventional case series of 12 eyes of 6 patients with AZOOR who received oral prednisone or oral prednisone plus intravitreal steroid (triamcinolone acetonide (IVTA, 2 mg/0.05 mL), dexamethasone (Ozurdex) implant, and/or fluocinolone (Retisert) implant. Patients were evaluated with visual acuity, intraocular pressure, and multimodal imaging. The duration of follow-up ranged from 7 to 65 months.
4 women and 2 men were included. The mean age at presentation was 53.5 years (range 36-72 years). All patients presented acutely/sub-acutely with photopsia and/or scotoma and were treated with oral prednisone. 4 patients also received treatment to cover for possible infectious etiologies while on high-dose prednisone. 9/12 eyes were treated subsequently with intravitreal steroids. 2 eyes received IVTA followed by Ozurdex, 1 eye received IVTA followed by Retisert, 2 eyes received IVTA alone, 3 eyes received Ozurdex alone, and 1 eye received Ozurdex followed by IVTA. Visual acuity remained stable or improved in 9 eyes. Visual acuity declined from 20/15 to 20/20 at final follow-up in both eyes of 1 patient. One eye declined from 20/30 to 20/40 in the setting of a subfoveal choroidal neovascular membrane which developed during the treatment course and was managed with serial intravitreal bevacizumab injections. All patients were stable off of systemic immunosuppression at final follow-up except one patient who remained on methotrexate and azathioprine. CellCept (mycophenolate mofetil) was discontinued after Retisert placement in one patient. Adverse events in eyes treated with intravitreal steroid included visually-significant cataract (1/10 phakic eyes) and increased intraocular pressure (5/12 eyes) that was controlled with topical medications. Among all eyes, IOP ranged from 10-28 mmHg, with an overall average increase of 2 mmHg between initial encounter and final follow-up.
Systemic and intravitreal steroids were effective in achieving disease stability in patients with AZOOR and were generally well-tolerated. Intraocular pressure must be monitored closely in patients treated with intravitreal steroids.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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