To describe a rare case of presumed bilateral acute idiopathic maculopathy (AIM) in a pediatric patient. An 11-year-old male was evaluated for a “fuzzy Dorito-shaped” spot in the central vision of his right eye (OD) that started 3 days before presenting to our clinic. On examination, best-corrected visual acuity (BCVA) was counting fingers at 5 feet OD, and 20/25 in the left eye (OS). Fundus examination demonstrated a central macular lesion with pigmentary changes OD and mild retinal pigment epithelium (RPE) changes OS. Optical coherence tomography (OCT) imaging showed elevated, irregular RPE with overlying subretinal fluid in the fovea OD and trace ellipsoid zone changes temporal to the fovea OS. Uveitis work-up was unremarkable for any infectious or inflammatory etiologies. Given the severe vision loss in the right eye and the negative infectious work-up, the decision was made to initiate oral corticosteroids in agreement with the patient's family. One week following the initial presentation, the patient developed visual symptoms OS without much improvement OD. The patient was admitted to the hospital, and further work-up revealed elevated coxsackie B3 antibody titers (1:20). Given the characteristic findings on multimodal imaging and elevated coxsackie B3 antibodies, the patient was presumptively diagnosed with bilateral AIM. Over the following 4 months, he would intermittently complain of nonspecific visual complaints such as blurry vision and floaters requiring an increase in corticosteroid dose and addition of immunomodulatory therapy, although the clinical examination and OCT findings remained unchanged. At the patient's follow-up visit 8 months after the initial visit, BCVA was stable at 20/40 OD and 20/30 OS, and OCT demonstrated stable foveal lesions in both eyes. This case report describes a rare presentation of presumed bilateral AIM in a pediatric patient. This prompts further consideration of this condition in pediatric patients, especially after a prodromal flu-like illness.

Gene therapy is an emerging field of medicine that can target and treat previously untreatable blinding or lethal diseases. Within the field of ophthalmology, gene therapy has emerged to treat retinal degenerative disorders, but its exact role is in its infancy. While this exciting frontier is rapidly expanding, these typically viral-based gene therapy vectors trigger a host immune response. Thus, a better understanding of the host immune response to gene therapies is critical, in that harnessing immunity to these vectors may improve treatment efficacy and reduce the risk of vision loss from inflammation. As such, we will discuss innate and adaptive immunity to gene therapy vectors, and avenues through which this response may be harnessed to improve visual outcomes.

Background/objective: Suprachoroidal triamcinolone acetonide (TA) was recently FDA-approved and is emerging as a new alternative to other local therapies for macular edema (ME) associated with noninfectious uveitis (NIU). The objective of this study is to evaluate the preliminary safety and efficacy of suprachoroidal TA in patients with refractory ME secondary to NIU. Methods: This was a retrospective review of a small cohort of patients with refractory ME secondary to NIU treated with suprachoroidal TA from November 2022 to October 2023. Results: Six eyes from five patients with refractory ME secondary to NIU were included in the study. The cohort included two females (40%), and the median age was 62 years (IQR = 8). Ophthalmic diagnoses included intermediate uveitis (n = 2; 40%), birdshot chorioretinopathy (n = 1; 20%), autoimmune retinopathy (n = 1; 20%), and panuveitis (n = 1; 20%). The median logMAR visual acuity was 0.7 (Snellen 20/100) at baseline and improved to 0.3 (Snellen 20/40) during follow-up visits at 1 month and 2–3 months. The median central subfield thickness (CST) was 690 μm at baseline and improved to 367.5 μm and 309 μm at the follow-up visits at 1 month and 2–3 months, respectively. The initial improvement in logMAR visual acuity and CST was less pronounced at follow-up visits at 6–7 months and 11–12 months. Conclusions: This study demonstrates the safety of suprachoroidal TA and efficacy signals, including improvement in visual acuity and ME at 3 months in patients with severe, refractory ME secondary to NIU.