Patient journey: steroids induced glaucoma with recurrent MESI over the course of approximately 2 years Failed treatments • Weekly adalimumab • Methotrexate • Cellcept • Azathioprine • Oral steroids • Difluprednate eyedrops Worsening macular edema with taper of difluprednate eyedrops Patient presented in August 2023 with a 12- year history of panuveitis of both eyes and multiple failed treatments Referred to a rheumatologist Referred to a glaucoma specialist Surgery #1: A combined cataract surgery and glaucoma surgery (OMNI canaloplasty) of the right eye in Jan 2024 IOP continue to rise despite surgery 1 Referred to a glaucoma specialist Surgery #2: Glaucoma tube shunt surgery of the right eye in May 2025 IOP now stable 2 Patient presented to uveitis specialist 3 4 Trial of bromfenac drops with initial improvement then worsening of macular edema IOP stable and macular edema now resolved after fluocinolone intravitreal injections Will evaluate further need for IMT next visit Developed worsening of chorioretinal lesions and macular edema Intraocular pressure (IOP) spikes to 40s with any steroids (topical eyedrops and intravitreal) For alternate immunomodulatory therapy (IMT) Attempted authorization for tocilizumab but insurance denied twice. Unable to get authorization for infliximab either Minimum macular edema initially Place back on difluprednate drops QID with spike of IOP to 38 53 This representative case is based on Dr. Quan Nguyen’s clinical experience, literature, and reviewed by uveitis consultants.