Topical difluprednate for the treatment of Harada's disease

Abstract

Purpose: To describe the use of topical difluprednate for treatment of patients who presented with Harada's disease.

Methods: Retrospective case series of patients managed with topical difluprednate alone at the onset of the diagnosis. The patients were followed with optical coherence tomography (OCT) and fluorescein angiography.

Results: In our three cases, complete resolution of the exudative detachments with improvement in visual acuity was achieved in each case. Central macular thickness was reduced by a mean of 365±222 μm. Initial loading dose was one drop every hour while awake, followed by a variable tapering regimen. Leakage on fluorescein angiography and exudative detachments on OCT both responded to treatment with difluprednate. In two of the three cases, the patients recovered vision to 20/20, and the third case recovered to 20/25. Steroid-induced glaucoma was observed and managed with one to two glaucoma drops as needed.

Conclusion: Difluprednate is effective for managing ocular manifestations of Harada's disease. Further studies of this drug for the management of noninfectious posterior uveitis are warranted.

Keywords: noninfectious posterior uveitis; serous retinal detachment; steroid.

Figure 1

OCT studies of Case 1. Notes: Case 1 OCT studies show exudative retinal detachment (white arrow) with RPE elevation (*), OS.OD at presentation (A). Resolving exudative detachment and RPE elevation after 2 and 9 days of treatment with topical difluprednate, respectively (B and C), and complete resolution of exudative detachment and RPE elevation (D) and stable macular contour one year after treatment (E). Abbreviations: OCT, optical coherence tomography; OD, oculus dexter (right eye); OS, oculus sinister (left eye); RPE, retinal pigment epithelium.

Figure 2

FA studies of Case 1. Notes: FA studies of Case 1 show fundus photos and FA studies showing disk hemorrhage OD, window defect from RPE atrophy OU, and disk leakage OU (A and B). Complete resolution of leakage OU (C) and fundus following treatment with difluprednate (D). Abbreviations: FA, fluorescein angiography; OD, oculus dexter (right eye); OS, oculus sinister (left eye); OU, oculus uterque (both eyes); RPE, retinal pigment epithelium.

Figure 3

OCT studies of Case 2. Notes: OCT studies of Case 2 show exudative detachment OS and mild macular thickening OD (A) with resolving detachment OS (B) and decreasing macular thickness OS with treatment using difluprednate. Resolution of the exudative detachment OS (C) and stable macular contour 6 months after treatment (D). Abbreviations: OCT, optical coherence tomography; OD, oculus dexter (right eye); OS, oculus sinister (left eye).

Figure 4

Fundus photos and FA studies of Case 2. Notes: Fundus photos (A) and FA studies of Case 2 show leakage OU consistent with Harada’s disease (B). Resolving leakage with treatment with difluprednate (C). Minimal leakage with continued use of difluprednate (D) and fundus photos following a course of treatment (E). Abbreviations: FA, fluorescein angiography; OD, oculus dexter (right eye); OS, oculus sinister (left eye); OU, oculus uterque (both eyes).

Figure 4

Fundus photos and FA studies of Case 2. Notes: Fundus photos (A) and FA studies of Case 2 show leakage OU consistent with Harada’s disease (B). Resolving leakage with treatment with difluprednate (C). Minimal leakage with continued use of difluprednate (D) and fundus photos following a course of treatment (E). Abbreviations: FA, fluorescein angiography; OD, oculus dexter (right eye); OS, oculus sinister (left eye); OU, oculus uterque (both eyes).

Figure 5

OCT studies of Case 3. Notes: OCT studies of Case 3 show exudative detachment OD and mild macular thickening OS (A). Resolving exudative detachment OD and decreasing macular edema OS with treatment with difluprednate (B–D). Complete resolution of exudative detachment OD one month following treatment (E) and remains stable 6 months following treatment (F). Abbreviations: OCT, optical coherence tomography; OD, oculus dexter (right eye); OS, oculus sinister (left eye).

Figure 6

Fundus photos and FA studies of Case 3. Notes: Fundus photos (A) and FA studies (B) of Case 3 showing disk leakage OU with diffuse leakage, OD.OS. Decreasing leakage OU with treatment with difluprednate (C) and complete resolution of leakage and fundus following treatment (D and E). Abbreviations: FA, fluorescein angiography; OD, oculus dexter (right eye); OS, oculus sinister (left eye); OU, oculus uterque (both eyes).

Figure 6

Fundus photos and FA studies of Case 3. Notes: Fundus photos (A) and FA studies (B) of Case 3 showing disk leakage OU with diffuse leakage, OD.OS. Decreasing leakage OU with treatment with difluprednate (C) and complete resolution of leakage and fundus following treatment (D and E). Abbreviations: FA, fluorescein angiography; OD, oculus dexter (right eye); OS, oculus sinister (left eye); OU, oculus uterque (both eyes).