Abstract
We report a patient with posterior scleritis who developed a recurrence on systemic immunosuppressive therapy that improved dramatically following an intravitreal dexamethasone implant. A 47-year-old male presented with sudden painless vision decline in the left eye of 3-day duration; corrected visual acuity was 20/200. The anterior chamber depth was shallow, and an exudative retinal detachment with peripheral shallow choroidal detachment was seen. B-scan ultrasonography confirmed findings typical for posterior scleritis. A short course of tapering oral steroids and chronic methotrexate treatment were initiated with resolution of the visual decrease and the ocular abnormalities. Despite the maintenance methotrexate, he returned with a complaint of new visual decline in the left eye. His best-corrected visual acuity was 20/30, and peripheral shallow exudative retinal with choroidal detachment was again noted. Oral steroids were returned to his regimen. His exudative retinal detachment continued to worsen, so pulse intravenous methylprednisolone therapy was started, resulting in minimal improvement. Furthermore, his immunosuppressives had to be modified due to systemic complications. Consequently, an intravitreal dexamethasone implant was injected into the left eye with subsequent improvement in his vision and resolution of his exudative retinal detachment.
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