Posterior iritis. What now?

[MRA]

I had Anterior iritis and that was cleared up in about 2 weeks with PredForte and Cyclogyl (after a failed one-week treatment with dexamethasone). But now, I have posterior uveitis (choroiditis) and an OCT shows a tiny dot of inflammation right behind my fovea. I am on PredForte every 2 hours and Xibrom twice daily. I have slight/moderate "waviness" on an Amsler grid (but no blank spots), and a slight general blurriness of my entire field of vision. My vision is about 20/22. A vision field test shows I have not lost any peripheral vision. I have no "black shroud" around the periphery. Even though the ophthalmologist says I am 1+ (I was previously 4+) inflamed, I see lots of white, fast, tiny, floaters when looking at the sky. I have had three different ophthalmologists say that they believe that I am "completely treatable" and they have ruled out macular degeneration and pars planitis using angiograpy, OCT, and vision field tests. They just the ordered bloodwork for the HLA-B27 gene and a few other things.

Questions:
* Do PredForte drops penetrate back to the choroid?
* Is PredForte the usual drug used for posterior choroiditis?
* What would be a normal interval for checking pressures when on PredForte 12x daily? My next checkup is in 2 weeks after stepping me up to every-other hour on the PredForte.
* How long should I "remain calm" before looking for results from the PredForte on reducing the blurriness?


Also...... About the 850 drops....
I am *not* looking for a flame war, and I appreciate all the time spent here by the moderators and users, but.... I have seen on this board time and time again about the magical "850 drops". Where does this data come from? I have had 3 different board-certified, highly decorated, ophthalmologists (one with 30 years of practice, and 12,000 corrective surgeries, and another who sits on the some medical board here in the Houston Medical Center and is also a professor, and the third designed many of the instruments that ops use in their practices every day) ALL tell me the same thing about the drops. One: the drops don't do *any* damage; the pressure they cause does. Two: only about 10 to 30% of the public is a "steroid responder" and if you aren't one of these, it is unlikely that thousands of drop would do *anything*. Three: they have many many patients that have been on PredForte for *years* (thousands of drops) with no problems; they also recognize that some *did* have problems and needed pressure management, but they were in a small minority. I mentioned the 850 drops thing, and the dr and his nurse immediately looked puzzled and asked, "Where in the world did you hear that? The Internet?" So.. I love to be fully informed. Can you tell me where the 850-drop data comes from?

PS. Please don't forget about the questions I asked before asking about the 850 drops. I appreciate your responses very much.

[Mike Bartolatz]

The 850 drops comment comes from C Stephen Foster MD, the top Ocular immunologist in the World who teaches opthalmology and ocular immunology at Harvard Medical School here in the USA. to say that corticosteroids don't cause problems, the increased pressure does, is rediculous to say the least. any side effect of a drug is CAUSED by the drug.
corticosteroid eyedrops cannot penetrate to the middle and back of the eye, corticosteroid injections or oral steroids are used to treat this type of inflammation. Perhaps you could see about a consultation with Professor Lewis at Baylor.
this is serious stuff when the posterior segment is involved. most often it is related to a systemic autoimmune disease or a pathogen.

I am not a doctor. you can verify my comments at http://www.uveitis.org the website of DR Foster. DR Foster's credentials are exceptional with with awards for getting things out of research and into practice. he is in 'who's who' too.

MODERN treatment would try to get you off all steroids without inflammation. for some individuals initially they don't have pressure problems but over time they can develop this problem. this happened with me. the steroid only approach cost me significant vision loss.

have you developed macular pucker, epiretinal membranes which might explain your wavy vision? Cystoid macular Edema?
the 'white spots' are not cells. they could be related to vascular problems or optic neuritis or traction on the retina from the vitreous detaching.

wish you the best,\
Mike

[MRA]

Mike,

Thanks for your response. After I noticed significant waviness on an Amsler grid, I went in to see the retina/macula specialist on the 23rd. I was in the process of tapering down from the PredForte after anterior iritis, but since the OCT showed swelling/edema in my choroid, he put me back to one drop every other hour with Xibrom 2x daily. Now after about 7 days, the Amsler grid has gone almost back to normal. The waviness is 85% gone, but the VERY tiny, FAST moving white dots are still zipping around in my eye. The white spots are not stationary blobs of white-out or blurriness. Plus my good eye has these, far less in number obviously, and my wife reports she can see them in her vision as well about once every few seconds. The overall picture is getting less blurry, but it is still nowhere as good as my unaffected eye. The grid only started clearing up yesterday. In the last 48 hours, there has been a dramatic improvement. I go back for a checkup and hopefully, to start coming down of the PredForte. The specialist confirmed that there is no detachment of either the retina or vitreous.

How long were you on the PredForte? Where your pressures high for a long time? I'm a little anxious waiting 2 weeks to check pressures after ramping up to 12x daily on the PredForte. Did you see the "rainbows" (I'm not)? My labs have not come back yet; it will be interesting to see what shows up. I just found out my birth-mother had RA at 30-ish years of age.

Anyway... Thanks for your response!
-MRA

[Mike Bartolatz]

no I didn't see rainbows. most people have no indication that pressure is elevated. I was on steriods for prolonged periods of time both drops, orally and injections as I had more than just iritis present. I also have a small spot of Vascular pulsation affect that has never gone away causing distortion along with epiretinal membranes (macular pucker). if the Xibrom doesn't help the CME, Avastin injections can help.

are you rheumatoid factor positive?
have you been tested for connective tissue diseases?
any arthritis present?
are you anti nuclear antibody positive?

Wish you the best,
mike

[Hudsongrl]

Another answer to an old post that may help someone else. The white flickering dot thing this poster mentions is caused by retinal inflammation due to the posterior uveitis. I had it too and my ocular immunologist said it can take months to resolve even after eyes are quiet. I describe it as visual snow, a pixelating type thing in my left eye. Mine is only visible in bright light, but yes, it can make things look a bit wavy. My retina and macula look normal he said, but it is an after effect of the posterior uveitis.hoping it resolves.