Intermediate uveitis complications

Visual acuity is often compromised on presentation in intermediate uveitis. A study in 2001 found a mean entering visual acuity of 6/12 (20/40) in patients with pars planitis on average, children with this disease were foimd to have worse visual acuity than adults at the time of initial presentation. CME is the most common cause of reduced acuity in intermediate uveitis. Other complications, including chronic vitreitis, cataract, and band keratopathy, may ensue in cases of untreated or undertreated intermediate uveitis, resulting in potentially significant visual compromise. 

It is important to perform gonioscopy only in recalcitrant cases of intermediate uveitis to rule out complications such as peripheral anterior synechia and neovascularization. Otherwise, this test is superfluous. 

Intermediate uveitis may not warrant any therapeutic intervention in mild cases where the visual acuity is 20/40 or better. However, medical therapy is required for most patients. Macular edema is a frequent complication and requires prompt management to prevent permanent vision loss. In general, topical steroids are minimally effective in intermediate uveitis, except in those patients who are aphakic. Periocular and systemic steroids are substantially more efficacious. Periocular steroid injections are preferable in unilateral presentations and in children, whereas oral or other systemic routes are required for bilateral cases. For steroid-resistant intermediate uveitis, immunosuppressive therapy or surgery (cryotherapy and vitrectomy) may be necessary. Complications associated with intermediate uveitis include persistent CME,... 

Band keratopathy is a relatively infrequent complication associated with long-standing uveitis. CME may result from the sustained release of prostaglandins however, this complication is fer more likely in cases of intermediate or posterior uveitis. 

---