DIAGNOSTICS, TREATMENT AND FOLLOW-UP OF AN ADULT PATIENT WITH INTERMEDIATE UVEITIS
Abstract
Intermediate uveitis is a chronic inflammatory eye disease where the vitreous is the major site of the inflammation. It mostly affects younger patients. The inflammation can be idiopathic or related to either infectious or autoimmune systemic disease. The leading cause of visual deterioration in intermediate uveitis is cystoid macular edema and cataract is the most common complication.
Criteria for treating intermediate uveitis depend on the cause of the disease. We consider the presence of cystoid macular edema, vitreous haze 2+ or more, retinal neovascularization or vasculitis. We decide to treat the patient early, because it is easier to preserve visual function and ocular structures. The basic approach to treatment is a »step approach«. We start the treatment with periocular, intraocular or systemic corticosteroids. If the treatment is ineffective we use immunosuppressants/immunomodulators. Prognosis is improved with early control of inflammation and early treatment of the complications.
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References
The standardization of uveitis nomenclature (SUN) working group. Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol. 2005; 140: 509–16.
Kanski JJ, Bowling B. Clinical Ophthalmology: A systematic approach. 7th Ed. Edinburgh, London, New York, Oxford, Philadelphia, St Louis, Toronto: Elsevier Saunders; 2011.
Nussenblatt BR, Whitcup MS. Uveitis: Fundamentals and clinical practice. 4th Ed. St Louis: Mosby Elsevier; 2010.
Vidović Valentinčič N, Kraut A, Hawlina M, Štunf Š, Rothova A. Intermediate uveitis: long- term course and visual outcome. Br J Ophthalmol. 2009; 93: 477–80.
Skuta LG, Cantor BL, Weiss SJ. Intraocular inflammation and uveitis. San Francisco: American academy of ophthalmology; 2012.
Foster CS, Vitale AT. Diagnosis and treatment of uveitis. 2nd Ed. New Delhi: Jaypee Brothers Medical Publishers; 2012.
Babu BM, Rathinam SR. Intermediate uveitis. Indian J Ophthalmol. 2010; 58: 21-7.
Messenger W, Hildebrandt L, Mackensen F, Suhler E, Becker M, Rosenbaum JT. Characterisation of uveitis in association with multiple sclerosis. Br J Ophthalmol. 2015; 99: 205–9.
Kalogeropoulos C, Koumpoulis I, Mentis A, Pappa C, Zafeiropoulos P, Aspiotis M. Bartonella and intraocular inflammation: a series of cases and review of literature. Clin Ophthalmol. 2011; 5: 817–29.
Roth DB, Chieh J, Spirn MJ, Green SN, Yarian DL, Chaudhry NA. Noninfectious endophthalmitis associated with intravitreal triamcinolone injection. Arch ophthalmol. 2003; 121: 1279-82.
Madow B, Galor A, Feuer WJ, Altaweel MM, Davis JL. Validation of a photographic vitreous haze grading technique for clinical trials in uveitis. Am J Ophthalmol. 2011; 152: 170–6.
Kempen JH, Sugar EA, Jaffe GJ, Acharya NR, Dunn JP, Elner SG, et al. Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema. Ophthalmology. 2013; 120: 1852–9.
Ossewaarde-Van Norel J, Camfferman LP, Rothova A. Discrepancies between fluorescein angiography and optical coherence tomography in macular edema in uveitis. Am J Ophthalmol. 2012; 154: 233–9.
Jittpoonkuson T, Garcia PM, Rosen RB. Correlation between fluorescein angiography and spectral-domain optical coherence tomography in the diagnosis of cystoid macular edema. Br J Ophthalmol. 2010; 94: 1197-200.
Gürlü VP, Alimgil ML, Esgin H. Fluorescein angiographic findings in cases with intermediate uveitis in the inactive phase. Can J Ophthalmol. 2007; 42: 107–9.
Jabs DA, Busingye J. Approach to the diagnosis of the uveitides. Am J Ophthalmol. 2013; 156: 228–36.
Parchand S, Tandan M, Gupta V, Gupta A. Intermediate uveitis in Indian population. J Ophthalmic Inflamm Infect. 2011; 1: 65–70.
Davis JL, Bloch- Michel E. Intermediate uveitis. In: Pepose JS, Holland GN, Wilhelmus KR, editors. Ocular Infection and Immunity. St Louis: Mosby; 1996. p. 676–93.
Kaplan HJ. Intermediate uveitis (pars planitis, chronic cyclitis) – a four step approach to treatment. In: Saari KM, ed. Uveitis Update. Amsterdam: Excerpta Medica; 1984:169-172.
De Smet MD. Corticosteroid Intravitreal Implants. Dev Ophthalmol. 2012; 51: 122–33.
Uveitis national managed clinical network treatment guideline development group. Scottish Uveitis National Managed Clinical Network Treatment Guidelines 2010. Dosegljivo 31.1.2016 s spletne strani: http://www.sun.scot.nhs.uk/Documents/uveitis%20treatment%20guideline%20sep%2020101revised%20.pdf.
Jabs DA, Rosenbaum JT, Foster CS, Holland GN, Jaffe GJ, Louie JS, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol. 2000; 130: 492–513.
Cunningham ET, Wender JD. Practical approach to the use of corticosteroids in patients with uveitis. Can J Ophthalmol. 2010; 45: 352-8.
Sen HN, Vitale S, Gangaputra SS, Nussenblatt RB, Liesegang TL, Levy-Clarke GA, et al. Periocular corticosteroid injections in uveitis: effects and complications. Ophthalmology. 2014; 121: 2275-86.
Choudhry S, Ghosh S. Intravitreal and posterior subtenon triamcinolone acetonide in idiopathic bilateral uveitic macular oedema. Clin Experiment Ophthalmol. 2007; 35: 713–8.
Lowder C, Belfort R Jr, Lightman S, Foster CS, Robinson MR, Schiffman RM, et al. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch ophthalmol. 2011; 129: 545-53.
Leung TG, Thorne JE. Emerging drugs for the treatment of uveitis. Expert Opin Emerg Drugs. 2013; 18: 513-21.
Gonzales Rubio-Medina E, Pedroza-Seres M. Clinical course of pars planitis in patients treated with selective photocoagulation. Arch Soc Esp Oftalmol. 2013; 88: 298-301.
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