Patient journey case: steroids induced glaucoma with recurrent MESI over the course of approximately 2 years This representative case is based on Dr. Quan Nguyen’s clinical experience, literature, and reviewed by uveitis consultants. Patient presented in Aug. 2023 with a 12-year history of panuveitis of both eyes and multiple failed treatments Minimum macular edema initially Developed worsening of chorioretinal lesions and macular edema Intraocular pressure (IOP) spikes to 40s with any steroids (topical eyedrops and intravitreal) Failed treatments • Weekly adalimumab • Methotrexate • Cellcept • Azathioprine • Oral steroids • Difluprednate eyedrops Worsening macular edema with taper of difluprednate eyedrops Trial of bromfenac drops with initial improvement then worsening of macular edema R E F E R R E D Surgery #1: A combined cataract surgery and glaucoma surgery (OMNI canaloplasty) of the right eye in Jan 2024 IOP continue to rise despite surgery For alternate immunomodulatory therapy (IMT) Attempted authorization for tocilizumab but insurance denied twice. Unable to get authorization for infliximab either Placed back on difluprednate drops QID with spike of IOP to 38 Surgery #2: Glaucoma tube shunt surgery of the right eye in May 2025 IOP now stable IOP stable and macular edema now resolved after fluocinolone intravitreal injections Will evaluate further need for IMT next visit R E F E R R E D R E F E R R E D 1 2 3 4 5 Patient presented to uveitis specialist Glaucoma specialist Rheumatologist 51