Intermediate Uveitis

Abstract

Intermediate uveitis is an intraocular inflammation involving the anterior vitreous, peripheral retina and pars plana. It usually affects patients from 5 to 30 years old, without gender or racial preferences. The etiology is unknown but there are several associated diseases: multiple sclerosis, idiopathic optic neuritis, autoimmune corneal endotheliopathy, sarcoidosis, thyroid diseases and inflammatory bowel diseases. Symptoms are blurry vision, floaters and distortion of central vision. The syndrome is bilateral in 80% of the patients and chronic with periods of exacerbation and remission. Clinical presentation includes: mild to moderate anterior chamber inflammation, thin keratic precipitates in the inferior portion of the cornea, autoimmune endotheliopathy, vitreitis, vasculitis in the peripheral retina, intravitreal "snowballs," retinal "snowbanking," optic neuritis and cystoid macular edema. Cataract and glaucoma are frequent complications. Treatment of intermediate uveitis is based on periocular and oral corticosteroids. Cryotherapy or laser photocoagulation of the peripheral retina are options in patients with snowbanking when there is an insufficient response to periocular or systemic corticosteroids. Imunosuppression may also be used when other therapies fail, and Cyclosporin A is the first drug of choice. Pars plana vitrectomy is indicated in patients with chronic significant inflammation, non-responsive cystoid macular edema, non-clearing vitreous hemorrhage, tractional retinal detachment and epiretinal membranes. The long-term prognosis of intermediate uveitis is usually good, particularly with strict control of inflammation and with proper management of complications. Patients can often maintain a vision of 20/50 or better.

Imunogenética das uveítes

“…Foram pesquisadas ainda associações dos polimorfismos dos genes das citocinas IL-6 (-174), IL-10 (-1082), TNF (-238 e -308) com ocorrência, curso e complicações da uveíte anterior, que foram negativas (21) . A quimiocina MCP-1 (CCL2), citocina envolvida no recrutamento de células mononucleares, já foi detectada em concentrações elevadas no humor aquoso de pacientes portaças infecciosas, como as causadas por vírus Epstein-Baar, HIV, HTLV-1, hepatite C, doença de Whipple, doença de Lyme, doença da arranhadura do gato, toxocaríase, tuberculose e sífilis (13) . Estabeleceu-se que a produção de IFNγ na presença do alelo -874T apresenta-se aumentada (14) .…”

Posterior vitreous cyst and intermediate uveitis

“…Vitreous manifestations in intermediate uveitis include vitreitis, aggregates of white exudates analogous to snowballs, and snowbank. 5 The vitreous cyst in our case may be a coincidental finding or may represent the result of vitreous degenerative changes following chronic irritation from the adjacent inflamed retina. We could also speculate that the vitreous cyst may constitute a rare transformation of previous large or coalesced snowballs.…”

Laser Photocoagulation in Intermediate Uveitis Associated with Retinoschisis

“…The term pars planitis is used by some authors for idiopathic intermediate uveitis, which shows no association with a systemic disorder. 1,2 Besides wellknown sight-threatening, chronic complications like band keratopathy, epiretinal membrane, retinal detachment, neovascularization, and vitreous hemorrhage, retinoschisis associated with pars planitis was also reported. 3,4 Herein, we report 3 cases of pars planitis associated with bullous retinoschisis in which laser photocoagulation was applied to limit the extent of the schisis.…”