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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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© ARVO (1962-2015); The Authors (2016-present)
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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