Intermediate uveitis
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Intermediate uveitis is a type of intraocular inflammation that primarily involves the vitreous and commonly the peripheral retina. It has a prevalence of 4.0-3.3 per 100,000 persons. Presentation includes blurry vision, floaters, pain, and redness. Treatment involves topical corticosteroids for unilateral disease and systemic corticosteroids like prednisone for bilateral disease. For cases with minimal response, immunosuppressants like methotrexate and mycophenolate may be used. Vitrectomy may be considered for diagnostic purposes or for cases with no response to medical therapy. With treatment, visual outcomes are often favorable though complications can include cataracts, glau
Intermediate uveitis
- 1. TITLE • Intrermediate Uveitis • Dr. Md. Mominul Islam • Fellow (Vitreo-Retina) • Ispahani Islamia Eye Institute And Hospital Dhaka • Bangladesh
- 2. INTRODUCTION • According to Standardized Uveitis Nomenclature Working Group “Intraocular inflammation in which the primary site is the vitreous but commonly involves the peripheral retina as well”
- 3. EPIDEMIOLOGY AND DEMOGRAPHY Prevalence 4.0 per 100 000 persons 3.3 per 100 000 persons Incidence 1.5 per 100 000 person-years 2.08 per 100 000 persons. At any age (average 31 years , more in younger) No gender and racial predilection Thorne and colleagues- more common in women (66.4%) Dev Ophthalmol 2010; 47:136-147
- 4. PRESENTATION & CLINICAL FINDINGS • Typically bilateral (74.5–80% bilateral) • Asymmetric unilaterally • Blurry vision and floaters • Pain • Redness • photophobia Anterior vitreous cells Diffuse vitreous haze Snowballs Snowbanks Peripheral vasculitis manifested by perivascular sheathing
- 5. Differential diagnosis of intermediate uveitis Infectious • Lyme disease • Syphilis • Toxocariasis • Toxoplasmosis • Tuberculosis Immune • Idiopathic (nearly 70%) • Pars planitis (36%) • Sarcoidosis (22.2%) • Multiple sclerosis (8%)
- 6. Masquerade • Lymphoma (usually B-cell, NHL) • Leukemia • Amyloidosis • Neoplasms • Irvine–Gass syndrome
- 7. Treatment Unilateral disease Active/CME Inactive/minimally with smolding CME Topcal corticosteroid and NSAIDs Good respons Posterior subtenon kenalog
- 8. after 3-4 weeks Good response Frequent 3 per year PSTK Minimum response PSTK 1st Good response Repeat PSTK/IVTA When active Flucinolone acetonide Implant Dexamethason intravitreal insert No/Minimum PSTK/IVTA 2nd Snowbank + Snowbank - Cryotherapy Vitrectomy If recurrence Systemic corticosteroid
- 11. Bilateral diseases Prednisone 1 mg/kg/day Good response After 2 weeks at maximum dose, Taper by 10mg/week until 20mg Then 15 mg Thentaper by 2.5 mg increments Minimum effective dose < 5 mg daily Prednisone Minimum effective dose < 5 mg daily Prednisone
- 12. Prednisone 1 mg/kg/day Minimum/No response Good response Mithotraxate 15-25 mg weekly +Folic acid 1 mg daily Minimum effective dose < 5 mg daily Prednisone Minimum/No response Azathioprine 50-250 mg PO Daily Mycophenolate mofetil 500- 1500mg PO BID Cytotoxic agent or T cell inhbitor Biologic (TNF – alpha or IL-2) Minimum /No response Consider vitrectomy
- 13. Ophthalmology. 1999 Jan;106(1):111-8. Methotrexate treatment for sarcoidosis associated panuveitis. Dev S, McCallum RM, Jaffe GJ. Source: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA. CONCLUSION: Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid- associated panuveitis
- 14. Comparison of antimetabolite drugs as corticosteroid- sparing therapy for noninfectious ocular inflammation. Galor A, Jabs DA, Leder HA, Kedhar SR, Dunn JP, Peters GB 3rd, Thorne JE. Source Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Conclusions These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate. Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2 agents.
- 15. VITRECTOMY • Therapeutic : a. No responsive to standard medical therapy • Diagnostic: a. Specimen sent for cytopathological evaluation and/or flow cytometry Herpetic viral infection Toxoplasma Intraocular lymphoma
- 17. CLINICAL COURSE Patients with Intermediate Uveitis Visual outcomes often – Favorable Mean visual acuity after 10 years of follow up-20/30 75% maintained V/A or – 20/40 or better One third maintained V/A – Normal without treatment
- 18. COMPLCATIONS • Vision loss due to CME – 41.2% over 15 years & 45.7% Uveitic Glaucoma Retinal detachment Vitreous haemorrhage Cataracts – 34.2% Epiretinal membrane 44.4% Band Keratopathy