PMC3975203_01
Ocular findings at initial presentation included bilateral posterior synechiae (a, right eye; b, left eye), macular edema (demonstrated by OCT, c, right eye; d, left eye), and peripheral retinal punched-out lesions (e, right eye; f, left eye).
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F1
Anterior segment examination revealed no corneal keratic precipitates, mild (+1) flare in the anterior chambers and posterior synechiae bilaterally (fig. 1a, b). Macular edema (fig. 1c, d) and peripheral retinal punched-out lesions were visible (fig. 1e).
Progression of the macular edema can be seen on OCT scans of the right eye (findings were similar in the left eye). At presentation (a), a significant macular edema was demonstrated, with an epiretinal membrane and mild vitreal opacification. Findings were stable at 3 months (b), but a worsening of the macular edema was noted at 6 months (c), and treated with an intravitreal injection of triamcinolone acetonide. Despite treatment and cessation of certolizumab, the macular edema persisted at 1 year (d).
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F2
Nevertheless, the macular edema persisted and the patient underwent periocular injections of 40 mg triamcinolone acetonide (Triesence; Alcon Inc.) in both eyes, with a partial resolution of the macular edema (fig. 2). The macular edema has improved, but still remains significant and is likely the cause of her impaired VA (fig. 2).