Purpose: To describe a case of inflammatory chorioretinopathy and Adie's syndrome possibly associated with COVID-19. Methods: Observational case report. Results: A 51-year-old woman developed fever, cough, and headache followed by retro-ocular pain and reading impairment. She tested positive for SARS-COV-2 infection by qualitative real-time reversetranscriptase-polymerase-chain-reaction. The slit-lamp and funduscopic exam revealed abnormal pupillary response and yellowish creamy deep chorioretinal lesions, which were not present in previous examinations. Instillation of pilocarpine demonstrated denervation supersensitivity, and it was suggestive of bilateral Adie tonic pupil. A comprehensive work-up ruled out other systemic, autoimmune, or infectious diseases. Conclusions: This case illustrates the possible association between multifocal chorioretinitis and Adie's syndrome, and the SARS-COV-2 infection in humans. Further investigation of virus infectivity specifically within ocular tissues has to be conducted.

Cystoid macular edema (CME) is a leading cause of blindness. In this study we assessed the efficacy and safety of Tocilizumab (TCZ) in refractory CME. DESIGN: Retrospective case series. METHODS: Patients with CME secondary to non-infectious uveitis who had inadequate response to corticosteroids and at least one conventional immunosuppressive drug, and in most cases to other biological agents were studied. CME was defined as central retinal thickness greater than 300 µm. The primary outcome measure was macular thickness. Intraocular inflammation, best corrected visual acuity (BCVA), and corticosteroid-sparing effect were also analyzed. RESULTS: A total of 25 patients (mean± SD age 33.6±18.9 years; 17 women) with CME were assessed. Underlying diseases associated with uveitis-related CME are juvenile idiopathic arthritis (n=9), Behçet's disease (n=7), birdshot retinochoroidopathy (n=4), idiopathic (n=4), and sarcoidosis (n=1). The ocular patterns were panuveitis (n=9), anterior uveitis (n=7), posterior uveitis (n=5) and intermediate uveitis (n=4). Most patients had CME in both eyes (n=24). TCZ was used in monotherapy (n=11) or combined with conventional immunosuppressive drugs. Regardless of the underlying disease, compared to baseline, a statistically significant improvement in macular thickness (415.7±177.2 vs 259.1±499.5 microns; p=0.00009) and BCVA (0.39±0.31 vs 0.54±0.33; p =0.0002) was obtained, allowing us to reduce the daily dose of prednisone (15.9±13.6 mg/day vs 3.1±2.3 p=0.002) after 12 months of therapy. Remission was achieved in 14 patients. Only minor side effects were observed after a mean follow up of 12.7±8.34 months. CONCLUSION: Macular thickness is reduced following administration of TCZ in refractory uveitis-related CME.

Anti-TNF-α therapy is effective and relatively safe in refractory BD uveitis.