Case Reports

Retinal ischemia in a cataractous patient during systemic steroids to gain weight

Case Report Details

First Author: J.Gendy EGYPT

Co Author(s):    A. Balamoun                    

Abstract Details

Purpose:

The effects of systemic steroids on the retina in a young healthy female patient taking oral steroids to gain weight presents with blurring of vision, debilitating enough to quit her job.

Setting:

National Eye Center, Cairo, Egypt

Report of Case:

On general examination it was normal except that she had a moon face. Meticulous questioning with the patient revealed that she had taken dexamethasone tablets to gain weight. This was thought to be the cause of glaucoma. The main concern was that she was no longer able to see and perform her job; another was to figure out the cause of the iris neovascularization. Although she had dense cataract her fundus was still visible; detailed examination was normal. Ultrasound and Ultrasound Biomicroscopy UBM revealed no abnormality detected. The cataract was removed from the better (left) eye first so that she can immobilise freely. This eye had a normal fundus and no signs of glaucoma. The only pathology in this eye was posterior sub-capsular cataract. Then it was the turn for the right eye; to remove the cataract but the Intra-ocular pressure (IOP) was very high, however the medical treatment managed to lower it enough to operate. Another fear was the large iris neovascularization; so she was injected 3 days pre-operative intra-cameral Avastin, which lead to regression. The cataract was then removed; but post-operative the vision did not improve. FFA was repeated at the peripheral retina which revealed peripheral retinal ischemia. Pan-retinal-photocoagulation was then performed which lead to no improvement of the IOP. Avastin was then injected intra-cameral which lead to regression of the iris neo-vessels but then soon recurred. The decision was taken to perform cryotherapy over the peripheral retina; but also no improvement. During cryotherapy the ciliary vessels were found to be very large; so cauterization was performed. This lead to a decrease in the neovascularization but it then soon recurred and the IOP was still high. Then cyclo-diode ablation was performed which managed to control the IOP but still no regression of the iris neo-vessels.

Conclusion/Take Home Message:

Keep your eyes wide open and question the patient thoroughly about their past medical history. No small detail is irrelevant in the history, do not leave it to the patient’s judgement what is relevant and what it not.

Financial Disclosure:

None