A patient, M 56, has a CME in syphilis. He took sigmacilline and now he's taking ceftriaxone with negative MRI of the brain.
Post-uveitic Cystoid Macular Edema is a challenge for the ophthalmologist. How would you treat this specific case? When to perform cataract surgery and which profilaxis would you adopt?
oCULAR SYPHILIS PATIENT SHOULD BE TREATED AS NEUROSYPHILIS PATIENT AS INTRAVENOUS PENICILLIN IS REQUIRED TO REACH THE DESIRED THERAPEUTIC CONC IN INTRAOCULAR CAVITY. PATIENTS DO WELL WITH PENICILLIN THERAPY. IF MACULAR EDEMA I TOO GROSS OR NOT MUCH RESPONDING TO PENICILLIN INTRAVITREAL TRICORT CAN BE TRIED BUT IOP RISE MUST BE KEPT IN MIND AS PT MIGHT BE SUFFERING FROM GLAUCOMA. OZURDEX IMPLANT CAN ALSO BE TRIED AS IOP RISE CHANCES ARE LESS WITH IT BUT IN CERTAIN CASES U MIGHT END UP DOING VIT TO REMOVE THE IMPLANT. SO PATIENT MUST BE PROPERLY COUNSELLED
I WOULD SUGGEST TO TAKE UP PATIENT FOR CATARACT SURGERY WHEN DS IS QUIET FOR ATLEAST 6 MONTHS WITH LONGER TAPER OF STEROIDS WITH PRE OP COVER OF STEROIDS. SUCH PT WOULD REQ CLOSER AND LONGER FOLLOW UP.
ONE OF THE IMP THING TO NOTE IS TO SCREEN OCULAR SYPHILIS PTS FOR HIV..
HOPE THIS HELPS
At the same time with specific general antisyphilitic therapy for ME is indicated topical nonsteroid antiinflamatory drops - voltarene ( diclophenac) indomethacine, etc. and PredForte , each four times dayli 1- 3 months, if not enough after 1 mo add Diamox oral or topical, if no response -Diprospan subtenonian injection or IV TA control of IOP