Decreased Vision on Routine Eye Exam

Bisant A. Labib, OD; Case Series Editor: Jean Marie Pagani, OD

Disclosures

November 04, 2015

Clinical Care and Treatment

Further probing of the patient's history revealed that the patient has had decreased vision in the left eye since her cataract surgery, and it had not improved for 2 years. She also reported mild noncompliance with post-cataract surgery drops.

Because of her history and absence of any other retinal abnormalities, she was presumed to have pseudophakic cystoid macular edema and was started on a treatment plan consisting of ketorolac four times daily and prednisolone acetate 1% four times daily in the left eye only.

At her 6-week follow-up, her visual acuity was 20/20 in the right eye and 20/40 in the left eye. Her intraocular pressures did not respond to topical steroid therapy and were 14 mm Hg in both eyes. OCT revealed a marked decrease in central macular thickness (Figure 2).

Figure 2. Marked reduction in elevation in the left eye and central thickness measuring 345 µm.

Topical therapy was continued, and the patient returned 1 month later with improvement in acuity: 20/20 for the right eye and 20/25+ for the left eye. Intraocular pressures were 13 mm Hg in both eyes. OCT showed a minimal decrease in central macular thickness in the left eye (Figure 3).

Figure 3. Central thickness measuring 331 µm in the left eye.

Owing to vision improvement and the stability of her macular thickness on OCT, the patient was started on a taper. She was instructed to reduce the ketorolac and prednisolone to three times per day for 1 week, then twice daily for 1 week, and finally once daily for 1 week in the left eye only.

She returned after the taper 3 weeks later with a visual acuity of 20/20 in the right eye and 20/25+ in the left eye. Intraocular pressures measured 13 mm Hg in both eyes. Her final OCT was completed (Figure 4).

Figure 4. Central thickness measuring 319 µm in the left eye.

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