✍️ refers to uveitis where the vitreous is the major site of inflammation
✍️ the term pars planitis may be used when
☝️ there is snowbank or snowball formation
☝️ in the absence of an associated infection or systemic disease (idiopathic).
✍️ accounts for around 10% of all cases of uveitis.
✍️ bimodal incidence
☝️ commonest in young adults
☝️ a second peak in the middle-aged and elderly.
✍️ female and male are equally affected.
✍️ bilateral in 80% but is often asymmetric.
✅Intermediate uveitis Clinical picture
✍️ Symptoms
☝️ Floaters
☝️ dropped VA (may indicate macular oedema)
☝️ may be asymptomatic.
✍️ Vitritis
☝️ cells
☝️ snowballs (colonies of cells )
☝️ snow banking
• exudation at the ora serrata
• commonly inferior but can be 360°
☝️ peripheral periphlebitis
☝️ rarely vitreous haemorrhage
☝️ some AC activity is common.
✍️ Complications
☝️ CME
☝️ cataract
☝️ 2ry glaucoma
☝️ cyclitic membrane
☝️ tractional retinal detachment (TRD)
☝️ retinal tears
☝️ vitreomacular traction ( VMT )
☝️ ERM
☝️ retinal neovascularization
☝️ retinoschisis.
✅Intermediate uveitis Investigation
✍️ lab 🔬
☝️ FBC
☝️ U+E
☝️ ESR
☝️ VDRL
☝️ TPHA
☝️ urinalysis
✍️ CXR for all patients
✍️ OCT or FFA may be helpful to confirm CME
✍️ other investigations according to clinical presentations
☝️ MRI brain ( CNS lymphoma)
☝️ LP
☝️ ACE and Ca level (sarcoidosis)
☝️ CT thorax ( sarcoidosis)
☝️ Bowel studies and biopsy ( IBD)
✅Intermediate uveitis Associations of intermediate uveitis
✍️ 1ry ocular
☝️ Idiopathic pars planitis
☝️ diagnosed After exclusion of other associations
✍️ 2ry systemic
☝️ MS
☝️ Sarcoidosis
☝️ IBD ( inflammatory bowel disorders)
☝️ CNS and intraocular lymphoma
✍️ 2ry infective
☝️ toxocara
☝️ Lyme disease
🌗🌗🌗🌗Treatment🌗🌗🌗🌗
✅Intermediate uveitis Observation
✍️ if no CME
✍️ VA >6/12
✅Intermediate uveitis Medical therapy
✍️ Topical in case of AC activity
☝️ topical corticosteroids
☝️ mydriatics (cyclopentolate 1% 2 ×/d).
✍️ Periocular or intraocular or systemic therapy is required in case of
☝️ CME
☝️ visually disabling floaters
☝️ periocular or intraocular treatments in case of
• unilateral
• very asymmetric disease
• cannot tolerate systemic therapy
✍️ Periocular
☝️ corticosteroid (orbital floor or sub-tenon’s )
• triamcinolone 40mg
• risk of increased IOP
☝️ intravitreal triamcinolone 2–4mg is well established
☝️ Sustained-release intravitreal devices include
• Retisert (0.59mg fluocinolone acetonide with estimated release 0.5 micrograms/d)
• Ozurdex (0.7mg dexamethasone)
• All intravitreal corticosteroids are associated with a risk of increased IOP , cataract and glaucoma and endophthalmitis.
✍️ Systemic
☝️ corticosteroids (prednisolone initially 1mg/kg/d
and titrating down )
☝️ pulsed methylprednisolone (500–1000mg three doses daily or alternate days)
☝️ immunosuppresives
• methotrexate
• mycophenolate
• azathioprine
• ciclosporin
normally reserved for
1- bilateral
2- resistant disease
3- intolerance to corticosteroid side effects.
☝️ anti-TNF (infliximab, adalimumab)
• in more resistant cases
• contraindicated in patients with MS.
✍️ Surgical therapy
☝️ Vitrectomy indicated in
• visually disabling vitreous opacities
• chronic resistant CME
• vitreomacular traction
• ERM
• retinal detachment.
☝️ phacoemulsification and IOL implant for
• visually disabling cataract
• intravitreal triamcinolone 4mg is given at the end of surgery unless contraindicated (known steroid-induced rise in IOP).
☝️ glaucoma surgery if there is a failure of medical therapy for IOP control.
