Hello! I want to share an interesting clinical case and to know your opinion. Male 56 years old 20 years ago he suffered a serious penetrating wound eye. Then he developed sympathetic neuroretinitis and the affected eye was subjected to evisceration. About two months ago (January 2016) a single eye visual function began to decline: visual acuity 7%, sensitivity retina decreased. OCT signs of edematous maculopathy to 400 microns. diabetes, AMD, central serous retinopathy, and other similar diseases are excluded. Fluorescein angiography shows cystic macular edema. Can we consider this as a relapse neuroretinitis? What do you think a possible approach to treatment? If I wrote a post is not there, then send me in the right topic.
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Sympathetic neuroretinitis
- Thread starter Dmi-pod
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Hello! I want to share an interesting clinical case and to know your opinion. Male 56 years old 20 years ago he suffered a serious penetrating wound eye. Then he developed sympathetic neuroretinitis and the affected eye was subjected to evisceration. About two months ago (January 2016) a single eye visual function began to decline: visual acuity 7%, sensitivity retina decreased. OCT signs of edematous maculopathy to 400 microns. diabetes, AMD, central serous retinopathy, and other similar diseases are excluded. Fluorescein angiography shows cystic macular edema. Can we consider this as a relapse neuroretinitis? What do you think a possible approach to treatment? If I wrote a post is not there, then send me in the right topic.
Does angiogram show vasculitis, disk leak or retinitis? Is there cell in the anterior chamber or vitreous? If so this may be a relapse of his SO and may need topical, peri ocular steroids and systemic immunosuppressive therapy
I have never seen S.O. but I've heard it looks very similar to VKH. Does he have a thick choroid or a "starry night" appearance of pinpoint leakage on FA? I guess I'd treat it similar to VKH. Systemic steroids 1-2mg/kg/day initially and immunomodulators. Would avoid intraocular steroid injections unless really needed because this is his only eye. Regarding IMTs, with VKH at least, I've seen cellcept, imuran and infliximab all seem to help and I've heard cyclosporin works as well.
That being said... I unfortunately (or fortunately for me) don't have much experience with S.O. In my area it's getting really hard to find a uveitis specialist who doesn't have a 3 month wait or more; by that point the patient is either blind or you've taken care of the issue. But it's an interesting case for sure -- Is there a way to post fundus/FA/OCT pictures of it here?
That being said... I unfortunately (or fortunately for me) don't have much experience with S.O. In my area it's getting really hard to find a uveitis specialist who doesn't have a 3 month wait or more; by that point the patient is either blind or you've taken care of the issue. But it's an interesting case for sure -- Is there a way to post fundus/FA/OCT pictures of it here?