Sequential Intravitreal Corticosteroid Rescue Including Ozurdex After Anti-VEGF Failure in Bilateral Uveitic Cystoid Macular Edema With Asymmetric Relapse.

Uveitic cystoid macular edema (CME) is a major cause of visual loss in patients with intraocular inflammation and may demonstrate inadequate response to anti-vascular endothelial growth factor (anti-VEGF) therapy. Intravitreal corticosteroids remain an important therapeutic option in inflammation-driven macular edema. This report describes the anatomical and functional course of bilateral uveitic CME refractory to anti-VEGF treatment and subsequently managed with sequential intravitreal corticosteroid therapy. A woman with bilateral uveitic CME was followed with serial optical coherence tomography and best-corrected visual acuity assessment. Initial evaluation showed marked bilateral macular thickening with reduced vision, more severe in the left eye. Despite repeated intravitreal anti-VEGF therapy, both anatomical and functional outcomes remained unsatisfactory, with persistent edema and visual deterioration. Treatment was then changed to bilateral intravitreal triamcinolone acetonide, after which substantial visual and anatomical improvement was observed in both eyes. The subsequent course was relapsing and asymmetric, with earlier recurrence in the left eye and later bilateral recurrence after missed follow-up. Because of the recurrent nature of the disease, bilateral dexamethasone intravitreal implant (Ozurdex) was administered, leading again to marked improvement in visual acuity and macular anatomy. This case demonstrates that bilateral uveitic CME refractory to anti-VEGF therapy may show limited response to repeated anti-VEGF treatment but substantial anatomical and functional improvement after sequential intravitreal corticosteroid therapy. It also highlights the relapsing and asymmetric course of inflammatory macular edema and the importance of individualized retreatment and close optical coherence tomography (OCT)-based monitoring.