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Resolution of refractory bilateral exudative retinal detachments with teprotumumab in a patient with thyroid eye disease and posterior scleritis
Presenter:
Dylann Fujimoto, MD
Authors:
Dylann K Fujimoto, MD; David J Merriott, MD; Olivia Lee, MD
Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA
Affiliation:
Purpose: To describe a case of chronic, refractory, bilateral serous retinal detachments in the setting of posterior scleritis and thyroid eye disease that resolved with teprotumumab. This case highlights a unique connection between posterior scleritis and thyroid eye disease and a novel modality to treat persistent serous retinal detachments unresponsive to traditional immunomodulatory therapy.
Methods: Clinical evaluation was conducted with visual acuity, intraocular pressure, dilated fundus examination, B-scan ultrasonography, and fluorescein angiography. Extensive systemic laboratory evaluation was performed to assess for infectious, inflammatory, and malignant etiologies. The patient underwent treatment for 2 years without resolution. Given persistent bilateral subretinal effusions, teprotumumab therapy was initiated. Clinical response was assessed by funduscopic examination and imaging.
Results: At initial presentation, visual acuity was 20/50 in the right eye and 20/25 in the left eye, with bilateral serous retinal detachments, more pronounced in the right eye. B-scan ultrasonography demonstrated choroidal thickening and serous retinal detachment in the right eye and serous retinal detachment in the left eye. Fluorescein angiography showed innumerable pinpoint hyperfluorescent spots in the right eye and was unremarkable in the left eye. Over the course of two years, the patient underwent multiple courses of treatment with systemic corticosteroids, periocular and intravitreal steroids, indomethacin, methotrexate, and biologic agents including adalimumab, rituximab, and infliximab. During this time serous retinal detachments persisted. The patient was initiated on teprotumumab for the treatment of the serous retinal detachments in the setting of quiescent thyroid eye disease. The left eye demonstrated complete resolution of subretinal fluid after 1 infusion, and the right eye showed complete resolution after 4 infusions, with sustained anatomic improvement.
Conclusions: This case illustrates that chronic bilateral serous retinal detachments in patients with thyroid eye disease may represent posterior scleritis complicated by orbital congestion, even when thyroid eye disease appears clinically inactive. The dramatic and durable response to teprotumumab suggests a potential therapeutic role for targeted treatment of orbital congestion in select refractory cases.