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Edit Comment Close Premium member Presentation Transcript Intermediate Uveitis: Intermediate Uveitis Dr. Billal Hossain National Institute of Ophthalmology and HospitalIntroduction: Introduction Idiopathic relapsing chronic disease Intraocular inflammation Centered around parsplanaDr Charles Schepens: Dr Charles SchepensHistory: History 1908: Fuchs - Cyclitis 1950: Schepens - Peripheral Uveitis 1960: Brockhurst - Peripheral Cyclitis 1960: Welch - Pars Planitis 1987: IUSG - Intermediate UveitisDefinition: Definition Predominantly Vitreous InflammationSITE OF INFLAMMATION: SITE OF INFLAMMATION Ciliary body Vitreous Peripheral retinaEpidemiology: Epidemiology 15% of uveitis patients 20% of Paediatric uveitis Bimodal presentation Bilateral 80% - asymmetricPathogenesis: Pathogenesis Cell mediated immunity Preponderance of T-helper cells HLA assosciation- A 28, DR 15Presentation: Presentation Floaters Blurring of visionClinical Findings: Clinical Findings Anterior Segment - Small KP - Epithelial oedemaClinical Findings: Clinical Findings Vitreous - Vitreous cell - Vitreous condensation - Snow ballsSnowball Exudate: Snowball ExudateClinical Findings: Clinical Findings Posterior segment - Periphlebitis - Snowbanking - Neovascularization - Disc oedemaSNOW BANKING : SNOW BANKINGClinical Findings: Clinical FindingsPARS PLANITIS: PARS PLANITIS Intermediate uveitis + snow bank - idiopathicClinical courses: Clinical courses Benign course Prolong course Variable courseComplications: Complications CME ERM Cataracts and Glaucoma Peripheral retinal vasoproliferative tumours Retinal Detachment and retinoschisis Optic Disc Edema Vitreous haemorrhageComplications: CME: Complications: CME 30% patientsComplications: CME: Complications: CMEComplications: CME: Complications: CMECME – Macular hole : CME – Macular holeComplications: ERM: Complications: ERMComplications: ERM: Complications: ERMComplications: ERM: Complications: ERMComplications: Cataracts: Complications: Cataracts 50% pt of uveitisComplications: Glaucoma: Complications: Glaucoma ? Herpes Gonioscopy ? Steroid responderComplications: RVPT: Complications: RVPT Dr. Shields and Associates 113 tumors- 13% IUComplications: Disc oedema: Complications : Disc oedema 20% of eye Secondary inflammation.Complications: RD: Complications: RD Exudative RD Tractional RD Rhegmatogenous RD RetinoschisisComplications: vitreous hge: Complications: vitreous hge Snowbank NVD NVE ChildrenComplications: Venous Sheathing: Complications: Venous Sheathing Vs.Cyclitic membrane: Cyclitic membraneHEALED PARSPLANITIS: HEALED PARSPLANITIS Aggregates cicatrize to form a limited membrane( gray or translucent) Associated slight atrophy of the parsplana or choroidHEALED PARSPLANITIS: HEALED PARSPLANITISSystemic associations: Systemic associations Multiple sclerosis SarcoidosisSarcoidosis: SarcoidosisDifferential Diagnosis: Differential Diagnosis Fuchs uveitic syndrome Primary intraocular lymphoma Peripheral toxocara granulomaFuchs uveitic syndrome: Fuchs uveitic syndromeInvestigations: Investigations General OcularFFA IN IU: FFA IN IUOCT IN PP: OCT IN PPUBM IN PARS PLANITIS: UBM IN PARS PLANITISBASIC APPROACH: BASIC APPROACH Is it uveitic or nonuveitic entity? What part or parts of uvea is involved? What is the stage of the disease? What is the cause of uveitis?Treatment: Treatment General Rules: - Always suppress the AC reaction - Obtain a dry macula.Four step approach: Four step approach 1. Post. Subtenon injection 2. Oral prednisolone 3. Immunosuppresive Agent 4. Indirect laser, Cryo, VitrectomyCATARACT EXTRACTION: CATARACT EXTRACTION Wait for burnt out stage May need to combine with PPV Counseling Counseling CounselingVR Surgery / combined : VR Surgery / combined Intractable inflammation Unresolved vit hge Retinal detachmentPrognosis: Prognosis Promptness and adequacy of treatmentSlide 50: Thank you You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.