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Chapter-18 Intermediate Uveitis

BOOK TITLE: Uveitis: Text and Imaging

Author
1. Biswas Jyotirmay
2. S Sudharshan
ISBN
9788184484915
DOI
10.5005/jp/books/11002_18
Edition
1/e
Publishing Year
2009
Pages
15
Author Affiliations
1. Sankara Nethralaya, Medical and Vision Research Foundation, Chennai, India, Sankara Nethralaya, Chennai, Tamil Nadu, India, Medical and Vision Research Foundation Sankara Nethralaya, 18, College Road Chennai, India, Medical and Vision Research Foundations, Chennai, Tamil Nadu, India, Medical and Vision Research Foundation, Shankara Nethralaya, Chennai, Sankara Nethralaya, Chennai, India, Medical Research Foundation, Sankara Nethralaya, Chennai, India, Sankara, Nethralaya, Chennai, Tamil Nadu, India, Sankara Nethralaya, A Unit of Medical Research Foundation, Nungambakkam, Chennai, Tamil Nadu, India, Sankara Nethralaya, Chennai, Tamil Nadu, Ind
2. Sankara Nethralaya, Chennai, India, Sankara Nethralaya, Chennai, Tamil Nadu, India
Chapter keywords
intermediate uveitis, anterior uveitis, vitreous cells, Slit lamp examination, Fluorescein angiography, cystoids macular oedema, Electrophysiological testing, fibroglial mass, Racemose neovascularisation, pars plana

Abstract

This chapter provides an overview of intermediate uveitis which is a term (clinical picture) with which clinicians are most uncomfortable because it has erroneously been used to describe a clinical entity whereas it is simply and should fully be used as an anatomical notion, like anterior uveitis, that includes several clinical entities. The disease has been found in 8 to 22% of uveitis patients and remains one of the commonly encountered uveitic entities all over the world. It is difficult to determine the age of presentation of this disease as it can remain mild or quiescent for several years. Hence the patients often do not report to the ophthalmologist at this stage. Intermediate uveitis may be underdiagnosed uveitic entity as early stages presenting with vitreous cells alone and without definite pars plana exudates can be missed, labelled and treated as anterior uveitis. Pars planitis, a specific entity within the anatomical group of intermediate uveitis, is characterised by cells and debris in the vitreous, exudates in the pars plana and peripheral retina. The disease is sometimes associated with mild periphlebitis in the vicinity of the exudates, and a non-granulomatous ‘spill over’ anterior uveitis that does not cause any synechiae. Slit lamp examination reveal a few cells in the anterior vitreous. Anterior uveitis can occur due to spill over of inflammation from the pars plana and is typically nongranulomatous. Fundus examination typically reveals multiple snow ball opacities in the vitreous in the peripheral fundus. Exudates though commonly seen inferiorly can also be identified in any other quadrant, though less frequently. Pars plana exudates in the periphery can transform into fibroglial mass. Racemose neovascularisation can occur in the late stages which can bleed. Fundus photography, Fluorescein angiography and OCT are quite useful in the management of intermediate uveitis especially in the detection of cystoids macular oedema. Electrophysiological testing may indicate widespread dysfunction of retina in some patients of intermediate uveitis.

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