Diagnostic Difficulties and Therapeutical Spectrum in the Treatment of Posterior Uveitis
Sturm V., Richard G.
Purpose: In Ophthalmology uveitis particularly needs a longer concept of treatment. Therefore a reliable differential diagnosis for a logical concept of therapy is necessary. We present a female patient with a posterior uveitis including some diagnostic impasses finally stabilized undergoing the whole cascade of treatment.
Method: Case report: A 58-year-old female patient presented with a multifocal posterior uveitis. Antiviral and antibiotic therapy elsewhere was frustrating. Serological results did not offer any diagnostic help. We clinically diagnosed a birdshot retinochoroidopathy (HLA-A 29 positive) and followed up the patient undergoing the whole spectrum of therapy for 29 months.
Results: Antiviral and antibiotic therapy elsewhere was frustrating. Local and systemic steroids achieved only a very limited clinical response. Especially the complication of chronic cystoid macular edema reduced visual acuity (VA 0,5/0,1). But finally immunsuppressive agents (mycophenolatmofetil) and pars plana vitrectomy have been employed with substantiated efficacy(VA 0,8/0,4).
Conclusions: Diagnosis and therapy lean on each other. A reliable diagnosis makes therapeutic decisions easier. Nevertheless caused by frequent complicate and cronic uveitis we need knowledge and often employment of the whole therapeutical repertory.
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