History of Present Illness
A 22-year-old healthy man is referred to the uveitis clinic for “intermediate uveitis and macular edema unresponsive to steroids” by an outside ophthalmologist. The patient reports that he has been having vision problems for years. About 6 months ago, he presented to a local ophthalmologist complaining of progressively decreasing vision. Outside records show that he was noted to have vitreal cells and macular thickening in both eyes (OU). He was placed on prednisone 60 mg by mouth (PO) daily for nearly a month without any improvement in vision or symptoms. He was then given intravitreal injections of triamcinolone 2 mg OU. Again, there was no subjective or objective improvement. Central macular thickness and volume remained unchanged. This was followed 2 months later by injections of triamcinolone 4 mg OU. Again, there was no response. At this point, the patient was referred for a second opinion.
| OD | OS | |
|---|---|---|
| Visual acuity | 20/100 | 20/100 |
| IOP | 35 | 40 |
| Sclera/conjunctiva | White and quiet | White and quiet |
| Cornea | Clear | Clear |
| Anterior chamber (AC) | Deep and quiet | Deep and quiet |
| Iris | Unremarkable | Unremarkable |
| Lens | Clear | Clear |
| Anterior vitreous | 1+ cells | 1+ cells |
| Dilated fundus examination (DFE) | See Fig. 65.1A | See Fig. 65.1B |
Optical coherence tomography (OCT) was performed to assess previously documented macular thickening ( Fig. 65.2 ).
