Topical NSAID an Option for Early Resolution of Macula Edema in Neuroretinitis? : A Case Report

Abstract Objective: To report a case of neuro retinitis in ocular bartonellosis which showed good response to topical nepafenac 0.1%, a non-steroidal anti-inflammatory drug, in addition to the standard treatment of systemic antibiotics. Result: A 14 year-old boy with history of cat scratch and fever prior to painless reduced vision of the left eye was clinically diagnosed as neuro retinitis characterized by optic disc swelling with subsequent development of macular star. He was started on topical nepafenac 0.1% which showed an improvement in visual acuity over 3 days. Oral azithromycin was subsequently started to treat the underlying cause neuro retinitis. Serologic examination for Bartonella henselae was positive for both immunoglobulin M and G. Patient responded well to treatment with final visual outcome of 6/6 and serial optical coherent tomography (OCT) of the macula showing resolution of macular edema at one month. Conclusion: Usage of topical nepafenac in combination with systemic antibiotics appears to be beneficial and hastens the visual recovery of patient. Further studies are needed to investigate the role of topical nepafenac as an alternative to systemic corticosteroids in cases of neuro retinitis in ocular bartonellosis.