Abstract
Purpose :
To evaluate the treatment response to topical steroidal eye drops in peripapillary pachychoroid syndrome (PPS), which is currently untreatable.
Methods :
In an observational study we examined 11 patients (17 eyes) with a diagnosis of PPS. Patients were followed for 2-10 years prior to treatment without any signs of reduction of the cysts. All included patients received topical Pred Forte 10mg/ml (PF) 3-times daily for four weeks. Upon a good response (absence of cysts) the topical steroids were tapered off by one drop a month.
Results :
Of the included 17 eyes, baseline visual acuity (VA) was 20/30. The median choroidal thickness was 202um at 3mm nasal of the fovea, 369um 1.5 nasal of the fovea, and 430um subfoveal. All patients showed a good response to topical steroids. Six patients experienced prolonged reduction of cysts even when dosage was reduced to once daily. On tapering of PF, 3 patients (4 eyes) had recurrence of cysts that subsequently disappeared when dosage was increased. The VA improved in 9 eyes, remained unchanged in 5 and decreased in 3 eyes. Four eyes experienced elevated IOP (range 26-32mmHg), for which in 2 eyes PF was discontinued upon which cysts returned.
Conclusions :
In this observational study for recalcitrant cystic changes because of PPS we saw a favorable response to topical steroids in all 11 cases. During tapering off of the steroidal drug recurrence of the cysts was experienced, that subsequently disappeared again upon increasing the topical drugs. The disappearance of the cysts resulted in better reading vision and better contrast but only mildly improved VA. Topical steroids may be a viable treatment option in PPS.
This is a 2020 ARVO Annual Meeting abstract.