From: Panuveitis-like reaction following encircling laser retinopexy/cerclage in a 21-year-old male
Week 1 | Day 1 post-laser |
• Hand motion, light perception in all quadrants vision | |
• + 3 brown cells, + 2 flare in anterior chamber; dense vitreous haze on dilated indirect ophthalmoscopy | |
• IOP 20 mmHg treated eye, 10 mmHg RRD eye | |
• Topical polymyxin + neomycin + dexamethasone shifted to prednisolone acetate 10 mg/mL q2 hours, atropine sulfate 1% 3×/day, and oral acetazolamide 125 mg 2×/day | |
Day 2 | |
• B-scan: low amplitude, mobile echoes in the mid to posterior vitreous, and prominent choroid (Fig. 1) | |
Day 4 | |
• 1-mm blood-tinged hypopyon (Fig. 2) | |
• IOP of 10 mmHg | |
• Topical prednisolone acetate increased to one drop hourly, topical moxifloxacin 5 mg/mL 6 drops q3 hours started | |
• Subconjunctival triamcinolone acetonide (10 mg) | |
Day 6 | |
• Patient admitted to hospital | |
Day 8 | |
• Oral prednisone 60 mg daily | |
Week 2 | • Cells and flare decreased to between + 1 and + 2, |
• Hypopyon resolved day 13 (Fig. 3) | |
Week 3 | • Pupillary synechiae, iris swelling 6–12-o’clock areas; dense, mobile, gray-brown retrolental sheets/membranes (Fig. 4) |
• B-scan: dense vitreous cells greatest towards posterior vitreous; mobile mid-amplitude echoes in nasal wall suspicious for exudative retinal detachment (Fig. 5) | |
• Ultrasound biomicroscopy: ciliary body cyst-like lesion and swelling, echoes in the space between the iris and lens 4–10 o’clock (Fig. 6) | |
• Oral immunosuppressive therapy, pars plana vitrectomy contemplated ➔ deferred due to stable condition, fear of pushing eye into phthisis | |
Week 4 | • B-scan: same features but decreased amplitude of echoes |
• 20/200 vision with and without pinhole on day 27 | |
• 20/70 correcting to 20/20 on pinhole vision on day 36 (Fig. 7) | |
• Fundus details first seen on indirect ophthalmoscopy day 30 | |
Week 6 | • Oral prednisone gradually adjusted to 40–50 mg/day |
Week 8 | • 20/20 uncorrected vision on day 59 with persistence of + 1 to 2 anterior chamber cells and flare, retrolental membrane (Fig. 11) |
• Macular OCT: generalized macular thickening > 99th percentile, preserved foveal anatomy, very visible posterior hyaloid face detached above the foveal depression (Fig. 8) | |
• Fluorescein angiography: normal dye transit, focal non-specific parafoveal staining, no evidence of vasculitis, phlebitis, delayed filling, gross macular edema nor ischemia (Figs. 9 and 10) | |
• B-scan: near-total resolution of previously observed lesions | |
Week 11 | • IOP ~ 25 treated eye, 30–35 RRD eye |
• Laser iridotomy and/or phacoemulsification contemplated ➔ deferred until resolution of inflammation | |
• Timolol maleate 5 mg/mL 2×/day started | |
• IOP decreased over following 2 days: 5–9 RRD eye, 17–19 treated eye (Figs. 11 and 12) |