History of Present Illness (HPI)
A 63-year-old woman underwent cataract surgery in the left eye (OS) about 3 months ago. The case was reportedly uncomplicated, and a one-piece intraocular lens (IOL) was placed in the capsular bag. Since then, she has had multiple episodes of what her cataract surgeon called “rebound iritis.” She was tapered off prednisolone acetate four times a day (QID) from postoperative week 1 to 4, promptly experienced a slight decrease in vision, and was noted to have white cells in the anterior chamber. Another week of prednisolone acetate QID was initiated, resulting in near resolution of the inflammation according to the surgeon’s notes, followed by another taper over 3 weeks. She presented postoperative week 8 with a similar presentation to week 4. Another 4 weeks of identical management with recurrent iritis again at week 12 then followed. At that point, she was referred to you on prednisolone acetate 1% twice a day (BID).
Past Ocular History
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Keratoconjunctivitis sicca both eyes (OU), controlled with preservative-free artificial tears and topical cyclosporine 0.05% BID OU
Past Medical History
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Gastroesophageal reflux disease
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Osteoarthritis
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Sjogren syndrome
| OD | OS | |
|---|---|---|
| Visual acuity | 20/25 | 20/30+ |
| Intraocular pressure (IOP) | 15 | 14 |
| Sclera/conjunctiva | White and quiet | White and quiet |
| Cornea | Clear | A few large keratic precipitates (KPs) |
| Anterior chamber (AC) | Deep and quiet | 2+ white cells |
| 1+ flare | ||
| Iris | Unremarkable | Unremarkable, no transillumination defect (TIDs) |
| Lens | 2+ nuclear sclerosis (NS) | See Fig. 13.1 |
| Anterior vitreous | clear | 2+ white cells, 0 haze |
| Nerve: | Cup-to-disc (c/d) 0.2, pink, sharp | c/d 0.2, pink, sharp |
| Macula: | Flat | Flat |
| Vessels: | Normal caliber and course | Normal caliber and course |
| Periphery: | Unremarkable | Unremarkable |
