Treatment Of Intermediate Uveitis Research Articles

Применение диодного лазера в комплексном лечении хронического периферического увеита и синдрома «сухого глаза»

Purpose. To evaluate the clinical and functional effectiveness of complex treatment of intermediate uveitis complicated by dry eye syndrome based on laser coagulation of chorioretinal structures near the toothed line using a diode laser. Material and methods. Clinical studies were performed among 98 patients who made up 2 observation groups: the main (78 people) and comparison (20 people). All patients were surveyed using the OSDI questionnaire, visometry, biomicroscopy, binocular ophthalmoscopy with sclerocompression, Schirmer I test, Norn test. Patients of the main group, along with conservative treatment, underwent laser coagulation of the extreme periphery of the retina, in the comparison group – conservative treatment. The follow-up period was 6 months. Results and discussion. The use of diode laser coagulation of chorioretinal structures near the toothed line in the complex treatment of intermediate uveitis occurring with dry eye syndrome reduces the number of complaints according to the OSDI questionnaire, positively affects the condition of the ocular surface, contributes to an increase in the parameters of the Schirmer I test and the Norn test, and in 100% of cases provides stable relief of inflammation of chorioretinal structures on the extreme periphery of the fundus. Conclusion. An integrated approach to the treatment of intermediate uveitis occurring with dry eye syndrome, using contactless diode laser coagulation of chorioretinal structures near the dentate line, allows achieving a significant reduction in signs of irritation of the ocular surface, up to their complete disappearance, providing rapid and stable relief of inflammation at the extreme periphery of the fundus in comparison with traditional pharmacotherapy. Keywords: dry eye syndrome, intermediate uveitis, peripheral laser coagulation of the retina.

Interferon versus Methotrexate in Intermediate Uveitis With Macular Edema: Results of a Randomized Controlled Clinical Trial

To compare interferon (IFN) beta with methotrexate (MTX) in the treatment of intermediate uveitis with macular edema. Monocentric, prospective, randomized, controlled clinical trial. Specialized uveitis center at the University of Heidelberg. PATIENT OR STUDY POPULATION: Patients with either primary intermediate uveitis or uveitis associated with multiple sclerosis. MAIN INCLUSION CRITERIA: Visual acuity of 20/30 or worse (0.2 logarithm of the minimal angle of resolution) and macular edema of more than 250 μm (central 1-mm in optical coherence tomography; Stratus). Randomization into either IFN beta 44 μg subcutaneously 3 times weekly or 20 mg MTX subcutaneously once weekly. At 3 months, the primary outcome parameter of mean change in visual acuity was evaluated and efficacy was determined. Secondary parameters were macular edema by optical coherence tomography, inflammatory activity, and retinal sensitivity by microperimetry (MP-1; Nidek). In case of treatment failure, switching to the other treatment arm was possible. Nineteen patients were included. Ten were randomized to MTX, and 9 were randomized to IFN beta. At 3 months, visual acuity improved a mean 0.31 logarithm of the minimal angle of resolution (range, -0.02 to -0.96, 15.6 letters on the Early Treatment Diabetic Retinopathy Study chart) in the IFN beta group versus a mean 0.09 logarithm of the minimal angle of resolution (range, 0.12 to -0.38, 4.7 letters) in the MTX arm (P = .0435, Mann-Whitney U test). Macular thickness decreased by a mean of 206 μm (range, -41 to -416 μm) in the IFN arm, but increased by 47 μm (range, 108 to -28 μm) in the MTX group (P < .0001). Although the sample size is small, results of the trial support superiority of IFN beta over MTX in the treatment of macular edema in the setting of intermediate uveitis.

Intermediate Uveitis in a Pediatric Italian Population

Purpose: To investigate clinical data, outcome, and treatment of intermediate uveitis in children.Methods: Retrospective cohort study, including 116 children affected by intermediate uveitis.Results: Sixty-two percent of patients were males. Ocular involvement was bilateral in 84%. Mean age at uveitis onset was 10.3 ± 3.6 years and 12.2 ± 7 years at first visit. Ninety-seven percent were classified as having idiopathic uveitis. The incidence of ocular complications during follow-up was 0.131/eye-year. Macular edema or a marked vitreous haze at presentation may be risks factors for incident visual loss. The most frequent causes of visual loss were macular edema (64%) and cataract (21%).Conclusions: Most cases are idiopathic (pars planitis); only few children presented associated systemic disease. Macular edema and severe vitritis at presentation are associated with increased risk of visual impairment. Cystoid macular edema is the main cause of visual impairment.

Clinical Characteristics and Treatments of Intermediate Uveitis

Purpose: To investigate the clinical characteristics and treatment of intermediate uveitis under new diagnostic standards. Methods: Medical records of patients diagnosed with pars planitis or intermediate uveitis were followed for more than 6 months, and retrospectively reviewed. Results: A total of 90 patients and 117 eyes were enrolled in the study. The mean age was 40.1 years, and the mean follow-up period was 43.0 months. Thirty percent of cases were bilateral. The most common initial symptom was decreased visual acuity. Snowbank was detected in 39.3%, snowballs in 15.4%, vitritis in 96.6%, and vasculitis in 56.4%. Common complications includedcystoid macular edema (57.3%), cataracts (43.6%), and epiretinal membrane (36.8%). Therapies included topical steroids (82.9% of cases), posterior sub-Tenon steroid injection (45.3% of cases), systemic steroid administration (67.8% of cases), and immunosuppressants (28.7% of cases). Vitrectomy was performed in 11.1% of patients due to complications such as epiretinal membrane and traction retinal detachment. The mean initial and final visual acuities were 0.67 and 0.74, respectively. Conclusions: The patients in this study experienced various courses of symptoms that required different treatment plans. Future investigations may corroborate these results.

Etanercept monotherapy induces complete resolution of cystoid macular edema in a patient with intermediate uveitis.

There is controversy on whether etanercept, an anti-tissue necrosis factor agent, shares infliximab's purported efficacy in the treatment of intermediate uveitis and, in particular, intermediate uveitis-associated cystoid macular edema. Interventional case report. A 29-year-old patient with decreased vision bilaterally secondary to cystoid macular edema complicating chronic idiopathic intermediate uveitis refractory to oral corticosteroids, methotrexate (17.5 mg weekly), and cyclosporine (100 mg daily) started etanercept monotherapy with rapid and complete resolution of cystoid macular edema and dramatic improvement in visual acuity. Etanercept may have a role in the treatment of refractory intermediate uveitis and intermediate uveitis-associated cystoid macular edema.

Intermediate Uveitis

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.

Posterior subtenon injection of corticosteroids using polytetrafluoroethylene (PTFE) intravenous cannula.

Injection of corticosteroids into the posterior subtenon space is a well established and highly effective modality in the treatment of intermediate uveitis. The conventional technique of posterior subtenon injection involves the use of a sharp tipped 26-gauge, 5/8 inch needle that must be inserted up to its hub to obtain adequate placement of the drug into the posterior subtenon space. With this technique the risk of perforation of the globe, although minimal, remains a potential complication. Herein is described a new technique for injection of corticosteroids into the posterior subtenon space using an intravenous cannula made of polytetrafluoroethylene (PFTE) that allows safer delivery of the drug into the posterior subtenon space.