Abstract
A 46-year-old man complained of loss of vision right eye (OD) and inability to see the top half of his visual field OD. Examination showed significant anterior chamber inflammation and a small pupil with nearly 360-degree synechiae. There was no view of the fundus. B scan showed an inferior retinal detachment that shifted with lying the patient supine. This presentation has a broad differential diagnosis, including inflammatory, infectious, and neoplastic etiologies. Broad laboratory testing was pursued and was positive only for HLA-B27. High-dose prednisone and frequent topical corticosteroids were administered, causing resolution of the anterior chamber inflammation but no change in the retinal detachment. Over the next 2 months, sub-Tenon’s triamcinolone was injected, prednisone was increased, and a trial of methylprednisolone 1000mg IV × 3 days were all administered, again with total stability in the retinal detachment, arguing against a rhegmatogenous retinal detachment. Pars plana vitrectomy with internal drainage resulted in resolution of the retinal detachment with improved vision.
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