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Ocular System

Intermediate uveitis (IU)

Inflammation in the anterior vitreous, ciliary body and the peripheral retina.

Aetiology

Etiology of IU (n = number of patients) | Ness, T., Boehringer, D., & Heinzelmann, S. (2017). Intermediate uveitis: pattern of etiology, complications, treatment and outcome in a tertiary academic center. Orphanet journal of rare diseases, 12(1), 81. https://doi.org/10.1186/s13023-017-0638-9

Clinical features

Bilateral in 80% of the patients and chronic with periods of exacerbation and remission

  • 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” (exudates on the pars plana)
  • Retinal “snowbanking“

Complications:

  • Optic neuritis
  • Cystoid macular edema (M/C cause of vision loss)
  • Cataract
  • Glaucoma
Complications of IU (n = number of patients) | Ness, T., Boehringer, D., & Heinzelmann, S. (2017). Intermediate uveitis: pattern of etiology, complications, treatment and outcome in a tertiary academic center. Orphanet journal of rare diseases, 12(1), 81. https://doi.org/10.1186/s13023-017-0638-9

Management

Kaplan’s stepladder approach:

  1. Periocular steroids (triamcinolone)
  2. Systemic/intravitreal steroids
  3. Cyclodestructive procedures (indicated in steroid refractory cases): Cryotherapy or laser photocoagulation of the peripheral retina
  4. Pars plana vitrectomy (indicated in chronic significant inflammation, non-responsive cystoid macular edema, non-clearing vitreous hemorrhage, tractional retinal detachment and epiretinal membranes)

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