Uveitis posterior

Severe acute and chronic allergic and inflammatory processes, keratitis, allergic corneal marginal ulcers, herpes zoster of the eye, iritis, iridocyclitis, chorioretinitis, diffuse posterior uveitis, optic neuritis, sympathetic ophthalmia, anterior segment inflammation... 

Ozerdem U, Levi L, Cheng L, Song MK, Scher C, Freeman WR. Systemic toxicity of topical and periocular corticosteroid therapy in an 11-year-old male with posterior uveitis. Am J Ophthalmol 2000 130(2) 240-1. 

Posterior snb-Tenon s injection of corticosteroids is most often nsed in the treatment of chronic eqnatorial and mid-zone posterior uveitis, including inflammation of the macnlar region. Cystoid macular edema after cataract extraction and diabetic macular edema are treated occasionally with snb-Tenon s repository steroids. 

Intravitreal triamcinolone has been used to treat diffuse diabetic macular edema. Also, an intravitreal implant delivering fluocinolone acetonide (Retisert) is effective in the treatment of patients with noninfectious posterior uveitis who have failed to respond to conventional treatment. 

Jaffe GJ, McCallum RM, Branchaud B, et al. Long-term follow up results of a pilot trial of a fluocinolone acetonide implant to treat posterior uveitis. Ophthalmology 2005 112 1192-1198. 

Anterior uveitis Posterior uveitis Sympathetic ophthalmia Sclera Scleritis Episcleritis Retina... 

Several extended-release devices able to deliver a consistent level of corticosteroid to the retina have been devised. Two will be presented in this chapter, although other devices are under evaluation or in the development pipeline at the time of writing. The primary indications for these devices are persistent macular edema associated with several conditions, including diabetic retinopathy, retinal vascular occlusive disease, cataract surgery, and posterior uveitis. 

Jaffe GJ, Martin D, CaUanan D, et al. Fluocinolone acetonide implant (Retisert) for noninfectious posterior uveitis. Fluocinolone acetonide implant (Resisert) for noninfectious posterior uveitus. Fluocinolone Acetonide Uveitis Smdy Group. Ophthalmology 2006 113 1020. 

Posterior uveitis Involves the choroid, overlying retina, and vitreous. The terms choroiditis, chorioretinitis, and retinochoroiditis are still used to describe specific conditions, for example, ocular histoplasmosis or acute retinal necrosis, but these conditions both technically constitute a posterior uveitis. 

Vitreous In all cases of uveitis it is important to evaluate the vitreous by direct and indirect means. Occasionally, a presumed anterior uveitis may simply represent spillover of inflammatory cells from an intermediate or posterior uveitis or a masquerade syndrome. ... 

Posterior uveitis is rarely a stand-alone diagnosis. Rather, this term is typically used to describe the manifestations of numerous inflammatory conditions involving the choroid and/or retina. The more common etiologies of posterior uveitis include toxoplasmosis, sarcoidosis, syphilis, histoplasmosis, and retinal white-dot syndromes. These conditions may affect a wide range of individuals with regard to age, gender, race, and national origin. 

Generally, patients with posterior uveitis present with symptoms of blmred vision and/or floaters, whereas ocular redness and pain are characteristically absent. The condition may present unilaterally or bilaterally depending on the underlying etiology. In fact, posterior uveitis can display a myriad of differing presentations, many of which are specific to the causative element. 

The visual acuity in posterior uveitis varies dramatically from case to case. Vitreitis, macular edema and/or exudate, subretinal neovascularization and/or hemorrhage, retinal detachment, and necrotic macular scarring may all serve to diminish acuity. In addition, the optic nerve may be involved in some infectious forms of posterior uveitis, such as toxoplasmosis, herpes, syphilis, or tuberculosis. Optic neuritis or neuroretinitis can further serve to compromise vision. 

Most often, patients with posterior uveitis display no external signs of inflammation. Ocular motility is rarely compromised. In cases of extensive unilateral involvement of the retina or optic nerve, a relative afferent pupillary defect may be noted otherwise, the external examination is entirely normal. 

Biomicroscopy of the anterior segment is often unremarkable in posterior uveitis. In cases of severe vitreitis, some spillover of inflammatory cells may be seen in... 

Panuveitis encompasses aspects of anterior, intermediate, and posterior uveitis. Hence, the diagnosis is made based on a compilation of signs and symptoms consistent with each of the aforementioned categories. A thorough evaluation is imperative whenever panuveitis is suspected. 

Deeper or more severe forms of uveitis may not respond to topical therapy hence, injectable and/or oral routes of administration may be required. Periocular corticosteroids may be used occasionally for anterior uveitis however, this therapy is more often used in cases of intermediate uveitis or, less commonly, unilateral posterior uveitis.A small amount of depot corticosteroid (e.g., 1 ml of 40 mg/ml triamcinolone acetonide injected superiorly or inferiorly in the orbit) is considered acceptable and appropriate treatment in such situations. In cases of chronic posterior uveitis or uveitis associated with CME, intravitreal triamcinolone has also been used with some success. A retrospective study in 2005 demonstrated that intravitreal injection of 4 mg/0.1 ml triamcinolone acetonide can effectively reduce CME and improve visual acuity and, in some eyes, allow for the reduction of immimosuppressive therapy. 

Another relatively recent development for the management of intermediate and/or posterior uveitis is the sustained-release intravitreal corticosteroid implant, for example, Retisert (fluocinolone acetonide 0.59 mg Bausch Lomb, Rochester, NY, USA). Retisert is indicated fc)r the treatment of chronic noninfectious uveitis affecting the posterior segment of the eye. An intravitreal dexamethasone implant is also currently luider investigation. 

Oral corticosteroids represent the treatment of choice for bilateral posterior uveitis and nonresponsive anterior or intermediate uveitis. Prednisone 0.5 to 1.0 mg/kg... 

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. 

After identifying the etiology, the general goals of therapy in posterior uveitis are to (1) preserve macular function,... 

Jabs DA, Akpek EK. Immunosuppression for posterior uveitis. Retina 2005 25 1-18. 

Clinical features of ARN must include (1) focal well-demarcated areas of retinal necrosis located in the retinal periphery, (2) rapid circumferential progression of necrosis, (3) evidence of occlusive vasculitis, and (4) moderate to severe anterior chamber and vitreal inflammation. Mild presentations may manifest low-grade anterior chamber inflammation with or without blurred vision, whereas severe cases may include episcleritis, scleritis, and pain on eye movement. Early clinical findings include anterior and posterior uveitis, keratic precipitates, and presence of vitreous cells. Within several days to weeks, the patient develops dramatic progressive retinal whitening in multifocal and confluent patches, vasculitis of both retinal arteries and veins, and possible optic nerve head... 

The primary vision-threatening manifestations of sarcoidosis are uveitis, glaucoma, and optic nerve involvement dry eye (keratoconjunctivitis sicca) is common but of lower risk. Anterior segment findings (including conjunctival granulomas, iris nodules, iridocyclitis, and keratoconjunctivitis sicca) occur in up to 70% of patients. In contrast, posterior uveitis occurs in up to 30% of patients. If only vasculitis, periphlebitis, or retinal neovascularization is considered, the frequency ranges from 4% to 17% of cases. Optic nerve involvement presents in up to 7% of patients. 

Certain episcleritis, anterior (rarely posterior) uveitis, anterior (rarely posterior) scleritis... 

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