RELENTLESS PLACOID CHORIORETINITIS RESPONSIVE TO INTRAVITREAL TRIAMCINOLONE AND SYSTEMIC ADALIMUMAB

The authors describe a case of relentless placoid chorioretinitis that was responsive to intravitreal triamcinolone and systemic adalimumab, but suboptimally responsive to oral prednisone.

: This is an interventional case report.

A 23-year-old woman presented with macular placoid chorioretinitis in the left eye and visual acuity of finger counting at 3 feet. Despite a 2-week course of 60 mg oral prednisone, the choroiditis expanded dramatically in the midperiphery. She was admitted to the hospital for high-dose IV corticosteroids, which stopped the progression of disease. After discharge, the patient was started on adalimumab and restarted oral prednisone; however, on resumption of oral prednisone 60 mg, the disease started to progress again over the next 2 weeks. An intravitreal injection of triamcinolone (intravitreal triamcinolone) 2 mg was given, which halted the progression of the disease for at least 9 weeks, at which time it was believed that the adalimumab started to also have an effect. The visual acuity 9 weeks after intravitreal triamcinolone had improved to 20/20. The patient was lost to follow-up after this point.

This is a case of relentless placoid chorioretinitis that continued to progress despite high-dose oral corticosteroids, but which responded to intravitreal triamcinolone and systemic adalimumab. This indicates that intravitreal corticosteroids may represent an alternative treatment option to oral corticosteroids in the short-term management of macula-threatening noninfectious chorioretinitis, particularly in patients with a suboptimal response to oral corticosteroids.