Systemic and topic

corticosteroids

Non steroidal anti-inflammatory

drops

Transient decrease of

macular edema of RE

1 intravitrealinjection of

triamcinolone in each eye

BCVA RE and LE: ↑ to 20/25

In the last visit the patient had

recurrence of macular edema in

the LE

In conjunction with gastroenterologist,

immunosuppressive therapy was

increased and we are considering

submit the patient to Ozurdex®

Crohn disease (CD) is primarily considered an inflammatory condition of the small and large intestine,

although associated extraintestinal inflammation is relatively common. Extra-intestinal manifestations of CD

occur in one third of patients. Ocular complications are infrequent, occurring in less than 10% of cases, but

can be associated with significant morbidity. Ocular manifestations are generally localized to the anterior

chamber and ocular surface but rarely can involve the posterior pole, orbit, and optic nerve.

This case is probably a rare example of posterior segment manifestation in CD. We are not sure if this is of

autoimmune etiology or an independent vascular disease of ischemic etiology. Other diagnostic tests,

including study of systemic vessels are essential for guiding diagnosis and future treatment.

Sílvia Monteiro MD, Inês Casal MD, Ana Figueiredo MD, Carolina Vale MD, Maria João Furtado MD, Angelina Meireles MD

Ophthalmology Department, Centro Hospitalar do Porto, EPE, Porto, Portugal

Department Director: Pedro Menéres MD

We report a case of a 61-years-old white man with the diagnosis of CD since five years ago. He was under

systemic treatment with azathioprin, adalimumab and salazopirin. The patient did not have diabetes

mellitus or arterial hypertension. He had history of an uneventful cataract surgery of both eyes in our

institution and had no other relevant ophthalmological history. Two months after the cataract surgery of

right eye (RE) he presented with decreased visual acuity of right eye (RE) from 20/30 to 20/60. One month

after the cataract surgery of left eye (LE), the visual acuity of LE also decreased from 20/25 to 20/60.

Anterior segment and IOP: normal

Fundus examination: extremely tortuous

retinal vessels, and arteriovenous crossing

changes on both eyes. No signs of vasculitis

or vitritis.

OCT: exuberant cystoid macular edema of

both eyes.

Fluorescein angiography: vascular

tortuosity, macular edema with fluorescein

leakage in macular zone; some ischemic

areas on posterior pole of both eyes.

Carotid doppler was normal. Serum

complement and immunoglobin levels were

normal and no autoantibody was detected.

All viral studies, quantiferon-TB, VDRL,

TPHA, and other biochemical studies

(angiotensin converting enzyme and plasma

lipid levels included) were negative.