Intermediate Uveitis ppt

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Presentation Transcript

Intermediate Uveitis:

Intermediate Uveitis Dr. Billal Hossain National Institute of Ophthalmology and Hospital

Introduction:

Introduction Idiopathic relapsing chronic disease Intraocular inflammation Centered around parsplana

Dr Charles Schepens:

Dr Charles Schepens

History:

History 1908: Fuchs - Cyclitis 1950: Schepens - Peripheral Uveitis 1960: Brockhurst - Peripheral Cyclitis 1960: Welch - Pars Planitis 1987: IUSG - Intermediate Uveitis

Definition:

Definition Predominantly Vitreous Inflammation

SITE OF INFLAMMATION:

SITE OF INFLAMMATION Ciliary body Vitreous Peripheral retina

Epidemiology:

Epidemiology 15% of uveitis patients 20% of Paediatric uveitis Bimodal presentation Bilateral 80% - asymmetric

Pathogenesis:

Pathogenesis Cell mediated immunity Preponderance of T-helper cells HLA assosciation- A 28, DR 15

Presentation:

Presentation Floaters Blurring of vision

Clinical Findings:

Clinical Findings Anterior Segment - Small KP - Epithelial oedema

Clinical Findings:

Clinical Findings Vitreous - Vitreous cell - Vitreous condensation - Snow balls

Snowball Exudate:

Snowball Exudate

Clinical Findings:

Clinical Findings Posterior segment - Periphlebitis - Snowbanking - Neovascularization - Disc oedema

SNOW BANKING :

SNOW BANKING

Clinical Findings:

Clinical Findings

PARS PLANITIS:

PARS PLANITIS Intermediate uveitis + snow bank - idiopathic

Clinical courses:

Clinical courses Benign course Prolong course Variable course

Complications:

Complications CME ERM Cataracts and Glaucoma Peripheral retinal vasoproliferative tumours Retinal Detachment and retinoschisis Optic Disc Edema Vitreous haemorrhage

Complications: CME:

Complications: CME 30% patients

Complications: CME:

Complications: CME

Complications: CME:

Complications: CME

CME – Macular hole :

CME – Macular hole

Complications: ERM:

Complications: ERM

Complications: ERM:

Complications: ERM

Complications: ERM:

Complications: ERM

Complications: Cataracts:

Complications: Cataracts 50% pt of uveitis

Complications: Glaucoma:

Complications: Glaucoma ? Herpes Gonioscopy ? Steroid responder

Complications: RVPT:

Complications: RVPT Dr. Shields and Associates 113 tumors- 13% IU

Complications: Disc oedema:

Complications : Disc oedema 20% of eye Secondary inflammation.

Complications: RD:

Complications: RD Exudative RD Tractional RD Rhegmatogenous RD Retinoschisis

Complications: vitreous hge:

Complications: vitreous hge Snowbank NVD NVE Children

Complications: Venous Sheathing:

Complications: Venous Sheathing Vs.

Cyclitic membrane:

Cyclitic membrane

HEALED PARSPLANITIS:

HEALED PARSPLANITIS Aggregates cicatrize to form a limited membrane( gray or translucent) Associated slight atrophy of the parsplana or choroid

HEALED PARSPLANITIS:

HEALED PARSPLANITIS

Systemic associations:

Systemic associations Multiple sclerosis Sarcoidosis

Sarcoidosis:

Sarcoidosis

Differential Diagnosis:

Differential Diagnosis Fuchs uveitic syndrome Primary intraocular lymphoma Peripheral toxocara granuloma

Fuchs uveitic syndrome:

Fuchs uveitic syndrome

Investigations:

Investigations General Ocular

FFA IN IU:

FFA IN IU

OCT IN PP:

OCT IN PP

UBM IN PARS PLANITIS:

UBM IN PARS PLANITIS

BASIC 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, Vitrectomy

CATARACT EXTRACTION:

CATARACT EXTRACTION Wait for burnt out stage May need to combine with PPV Counseling Counseling Counseling

VR Surgery / combined :

VR Surgery / combined Intractable inflammation Unresolved vit hge Retinal detachment

Prognosis:

Prognosis Promptness and adequacy of treatment

Slide 50:

Thank you