Tocilizumab for Silicone Oil-Induced Recalcitrant Cystoid Macular Edema in a Patient with Recurrent Acute Retinal Necrosis-Associated Retinal Detachment.

Purpose: We report a case of refractory silicone oil-induced cystoid macular edema in a patient with recurrent acute retinal necrosis-related retinal detachments successfully treated with tocilizumab without silicone oil removal nor reactivation of the acute retinal necrosis.

Methods: Single-patient case report.

Results: A monocular patient with recurrent acute retinal necrosis-related retinal detachments necessitating indefinite silicone oil tamponade developed intractable cystoid macular edema immediately after silicone oil placement that was unresponsive to multiple therapies over nearly a year. After a single dose of tocilizumab, the patient demonstrated significant clinical improvement with resolution of the macular edema and reduction in petaloid macular leakage on fluorescein angiography. With continued tocilizumab treatment, silicone oil tamponade could be maintained, and no reactivation of acute-retinal necrosis was noted.

Conclusion: This case represents the first documented successful use of tocilizumab in treating silicone oil-induced recalcitrant cystoid macular edema. When silicone oil cannot be removed from an eye and when steroids risk reactivating viral retinal disease, tocilizumab may offer a safe and effective treatment alternative for such macular edema.