Uveitis
Intermediate uveitis
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Get access- The vitreous is the major site of inflammation
- ‘Pars planitis’ refers to snowbank or snowball formation without infection or systemic disease
- Bimodal
- Commonest in younger adults
- Second peak in middle-age
- M=F
- 80% bilateral
Clinical features
- Floaters
- Reduced vision: predominantly due to CMO
- Asymptomatic
- Vitritis: snowballs or snowbanking (exudation at the ora serrata)
- Periphlebitis
- Vitreous hemorrhage (rare): may be the presenting feature especially in children
- AC activity
Tests
- Routine blood panel
- Syphilis serology
- ACE
- Lyme serology
- Toxocara serology
- MRI brain and LP if MS suspected
Management
-
Topical corticosteroids if significant AC activity
-
Periocular steroid eg. orbital floor or sub-Tenon’s, for disabling floaters or CMO
-
Systemic steroid, for floaters or CMO
- 1mg/kg/d prednisolone on a titrating regime
- Pulsed IVMP if severe (reserved for bilateral or resistant disease
-
Intravitreal steroid: Retisert, Ozurdex (licensed for non-infectious posterior segment uveitis), Iluvien
-
anti-TNF agents: VISUAL RCT showed adalimumab was effective in non-infectious posterior uveitis
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Surgery:
- Vitrectomy
- Cataract surgery
- Glaucoma surgery