When steroids help and harm: the challenge of managing glaucoma in MESI patients requiring ocular steroids 0 20 40 60 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 Intraocular Pressure Maximum glaucoma medications given but eye pressure still too high Combined glaucoma tube shunt surgery + complex cataract surgery After surgery, inflammation flared up and eye pressure was still elevated which led to irreversible vision loss from glaucoma The stronger the steroid, the stronger the side effects For example, RETISERT® (fluocinolone acetonide intravitreal implant) label: • 60% of patients will require chronic IOP lowering medications to control intraocular pressure and 37% will require filtering procedures to control intraocular pressure • Within an average post- implantation period of approximately 2 years, nearly all phakic eyes are expected to develop cataracts and require cataract surgery 107 This representative case is based on Dr. Quan Nguyen’s clinical experience, literature, and reviewed by uveitis consultants.