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Frederick David Nelson, Samuel Hobbs, Halward Blegen, Paul M Drayna; Managing Sympathetic Ophthalmia with Topical Steroids: A Case Series. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5352.
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To date, the mainstay of therapy for sympathetic ophthalmia (SO) has been systemic immunomodulatory therapy. However, in patients where systemic therapy may be contraindicated, there is evidence that topical therapy alone can result in disease remission. We present 2 patients with SO successfully managed with topical therapy alone who achieved and maintained remission.
This is a retrospective, observation case series in a single-center setting. Two patients were included with a diagnosis of SO who had significant contraindications to systemic therapy. Topical difluprednate was used to treat both patients.
Case 1: A 65-year-old female developed SO after a complicated cataract extraction of the left eye (OS). On post-operative week five, she developed serous retinal detachments and panuveitis in both eyes (OU), and her best-corrected visual acuity (BCVA) decreased from 20/20 OU to 20/70 in the right eye (OD) and 20/60 OS. Systemic steroids were contraindicated due to recent pathologic fractures and other comorbidities. She was successfully treated with difluprednate and achieved remission of her disease after 4 weeks of therapy. The patient regained 20/20 BCVA OU and is currently maintained on daily difluprednate. She has not experienced disease recurrence after four months of therapy.Case 2: An 80-year-old male with a complicated ocular history OS, including secondary anterior chamber intraocular lens placement; penetrating keratoplasty; and subsequent development of poorly controlled glaucoma, developed SO after minimally invasive glaucoma surgery complicated by hemorrhagic choroidal detachment. Three weeks after glaucoma surgery, he developed panuveitis OD, and his vision in that eye decreased from 20/20 to 20/80 BCVA. Systemic immunotherapy was contraindicated due to a recent gastrointestinal bleed of unknown origin that began after using systemic steroids to treat his choroidal detachment OS. He was started on difluprednate therapy OD. He returned to 20/20 BCVA OD after 5 weeks of difluprednate monotherapy, with rare cell and no vitritis. The patient has been in remission on daily difluprednate for 2 months without recurrence.
Topical steroid therapy may be an alternative to systemic immunosuppressive therapy in maintaining remission of sympathetic ophthalmia in patients with significant contraindications to systemic therapy. Additional research is required to confirm these results.
This is a 2020 ARVO Annual Meeting abstract.
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