PMC4310279_01
OCT studies of Case 1.. Notes: Case 1 OCT studies show exudative retinal detachment (white arrow) with RPE elevation (*), OS.OD at presentation (A). Resolving exudative detachment and RPE elevation after 2 and 9 days of treatment with topical difluprednate, respectively (B and C), and complete resolution of exudative detachment and RPE elevation (D) and stable macular contour one year after treatment (E).. Abbreviations: OCT, optical coherence tomography; OD, oculus dexter (right eye); OS, oculus sinister (left eye); RPE, retinal pigment epithelium.
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OD. OCT studies confirmed the presence of subretinal fluid (SRF) and revealed irregular elevations of the retinal pigment epithelium (RPE) OU (oculus uterque, both eyes) (Figure 1A). OD and 13 OS. OCT studies showed gradual resolution of the SRF and RPE elevations, while FA studies showed reduced leakage (Figures 1B, 1C, and 2C). After this initial 4-week course of treatment, normal macular contour was maintained, and the patient was switched to topical loteprednol BID for 6 months (Figures 1D and 2D). A year after her initial presentation, OCT studies showed absence of SRF in both eyes (Figure 1E).
FA studies of Case 1.. Notes: FA studies of Case 1 show fundus photos and FA studies showing disk hemorrhage OD, window defect from RPE atrophy OU, and disk leakage OU (A and B). Complete resolution of leakage OU (C) and fundus following treatment with difluprednate (D).. Abbreviations: FA, fluorescein angiography; OD, oculus dexter (right eye); OS, oculus sinister (left eye); OU, oculus uterque (both eyes); RPE, retinal pigment epithelium.
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FA showed a disk hemorrhage OD with leakage from the macula and optic disc OU (Figure 2A and B). No perfusion defects were present, arguing against a vasculitis process (Figure 2B). OD and 13 OS. OCT studies showed gradual resolution of the SRF and RPE elevations, while FA studies showed reduced leakage (Figures 1B, 1C, and 2C). After this initial 4-week course of treatment, normal macular contour was maintained, and the patient was switched to topical loteprednol BID for 6 months (Figures 1D and 2D).
PMC4310279_02
OCT studies of Case 2.. Notes: OCT studies of Case 2 show exudative detachment OS and mild macular thickening OD (A) with resolving detachment OS (B) and decreasing macular thickness OS with treatment using difluprednate. Resolution of the exudative detachment OS (C) and stable macular contour 6 months after treatment (D).. Abbreviations: OCT, optical coherence tomography; OD, oculus dexter (right eye); OS, oculus sinister (left eye).
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OCT studies confirmed the serous macular detachment OS with cystoid macular edema (CME) OU (Figure 3A). OU. OCT and FA studies showed a marked improvement with decreased SRF OS and reduced leakage, respectively (Figures 3B and 4C). OD and 20/30 OS with pinhole to 20/25 OS. OCT studies showed resolution of the serous detachment OS and decreased activity on FA studies (Figures 3C and 4D). At 6 months, she was reevaluated clinically and with imaging, which showed that her lenses remained clear and vision remained stable at 20/20- OD and 20/25- OS with IOP of 18 OD and 20 OS while continuing management with difluprednate 0.05% qd OU, bromfenac 0.07% qd OS, and dorzolamide 2%/timolol 0.5% BID OU (Figures 3D and 4E).
Fundus photos and FA studies of Case 2.. Notes: Fundus photos (A) and FA studies of Case 2 show leakage OU consistent with Harada's disease (B). Resolving leakage with treatment with difluprednate (C). Minimal leakage with continued use of difluprednate (D) and fundus photos following a course of treatment (E).. Abbreviations: FA, fluorescein angiography; OD, oculus dexter (right eye); OS, oculus sinister (left eye); OU, oculus uterque (both eyes).
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FA studies revealed punctate leakage in the macula and disk leakage OU late in the study (Figure 4A and B). OU. OCT and FA studies showed a marked improvement with decreased SRF OS and reduced leakage, respectively (Figures 3B and 4C). OD and 20/30 OS with pinhole to 20/25 OS. OCT studies showed resolution of the serous detachment OS and decreased activity on FA studies (Figures 3C and 4D). At 6 months, she was reevaluated clinically and with imaging, which showed that her lenses remained clear and vision remained stable at 20/20- OD and 20/25- OS with IOP of 18 OD and 20 OS while continuing management with difluprednate 0.05% qd OU, bromfenac 0.07% qd OS, and dorzolamide 2%/timolol 0.5% BID OU (Figures 3D and 4E).
PMC4310279_03
OCT studies of Case 3.. Notes: OCT studies of Case 3 show exudative detachment OD and mild macular thickening OS (A). Resolving exudative detachment OD and decreasing macular edema OS with treatment with difluprednate (B-D). Complete resolution of exudative detachment OD one month following treatment (E) and remains stable 6 months following treatment (F).. Abbreviations: OCT, optical coherence tomography; OD, oculus dexter (right eye); OS, oculus sinister (left eye).
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Dilated funduscopic exam revealed 1+ cells in the AC and vitreous cavity, and a serous detachment with RPE elevation in the macula OD, which was confirmed by OCT studies (Figure 5A). On day 3, there was a marked decrease in SRF OD on OCT studies (Figure 5B). On day 10, VA improved to 20/60 OD and 20/25 OS with continued resolution of the SRF OD (Figure 5C). OD, 20/40 OS, PH to 20/20 OS with resolution of the RPE elevation with mild residual SRF (Figure 5D), so the difluprednate was reduced to every 2 hours while awake. On day 31, OCT studies showed resolving displacement of the exudative detachment, but she now presented with increasing severity of headaches (Figure 5E). At her 6-month follow-up, the macular contour remained stable in both eyes, and her vision improved to 20/20 OD and 20/20 OS, and IOP recovered to 15 OD, 14 OS (Figures 5F, 6D, and 6E).
Fundus photos and FA studies of Case 3.. Notes: Fundus photos (A) and FA studies (B) of Case 3 showing disk leakage OU with diffuse leakage, OD.OS. Decreasing leakage OU with treatment with difluprednate (C) and complete resolution of leakage and fundus following treatment (D and E).. Abbreviations: FA, fluorescein angiography; OD, oculus dexter (right eye); OS, oculus sinister (left eye); OU, oculus uterque (both eyes).
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FA studies showed leakage in the macula and optic disc as well as punctate focal hyperfluorescent spots late in the study OU (Figure 6A and B). FA studies were again performed, which showed persistent leakage from the macula and optic disc late in the study OU (Figure 6C). At her 6-month follow-up, the macular contour remained stable in both eyes, and her vision improved to 20/20 OD and 20/20 OS, and IOP recovered to 15 OD, 14 OS (Figures 5F, 6D, and 6E).