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Immunotherapy of Uveitis
Published in George S. Eisenbarth, Immunotherapy of Diabetes and Selected Autoimmune Diseases, 2019
Roberto de Bara, Alan G. Palestine, Robert B. Nussenblatt
Inflammation concentrated in the vitreous is known as intermediate uveitis. In this form of inflammation the posterior portions of the retina are not primarily involved but the retina may in some cases be secondarily affected. Pars planitis is an example of this type of uveitis in which patients usually complain of decreased vision and floaters. The floaters are secondary to inflammatory clumps of cells and debris within the vitreous that are seen as black spots because they impede the flow of light to certain areas of the retina. In pars planitis, vitreal inflammation may also result in decreased vision by the production of cystoid macularedema, an accumulation of fluid within the retina. Intermediate uveitis may occur in one eye or be bilateral, and it may present simply as an ocular disease or be associated with a systemic illness such as sarcoidosis. Treatment is usually in the form of periocular or systemic steroids and the clinical course is variable. Some patients respond well to steroid treatment while others develop disease recalcitrant to therapy and have permanent visual loss.
Intermediate uveitis
Published in Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen, Practical Uveitis, 2017
Gwyn Samuel Williams, Mark Westcott
Intermediate uveitis is said to be present when the primary focus for the inflammation is in the ciliary body and anterior vitreous. The old name for intermediate uveitis, ‘peripheral uveitis’, is perhaps useful as well as it characterises the condition as a particular form of posterior uveitis in which the signs are only to be seen very peripherally in the posterior segment. As with anything that is not specifically one thing or another there is some confusion surrounding this condition with an alternative name ‘pars planitis’, which in fact describes a particular subset of patients within this group, sometimes being used interchangeably to describe any patient with intermediate uveitis. Probably the simplest definition of intermediate uveitis is inflammation in which the anterior vitreous is more involved than the anterior chamber and in which there may be very peripheral retinal signs present. It accounts for up to 15% of all cases of uveitis.
Intermediate Uveitis: A Review
Published in Ocular Immunology and Inflammation, 2023
Andrea York Tiang Teo, Bjorn Kaijun Betzler, Keith Low Qie Hua, Elizabeth Jiahui Chen, Vishali Gupta, Rupesh Agrawal
Pars planitis is a type of noninfectious IU not associated with systemic disease that presents with vitritis and either inferior vitreous inflammatory condensates (“snowballs”) or pars plana “snowbanks.”87 Snowbanks are formed from post-inflammatory glial proliferation of fibrous astrocytes,88 resulting in the deposition of a grey-white fibrovascular and/or exudative plaque at the pars plana, whereas snowballs are yellow-white inflammatory aggregates found in the mid-vitreous and inferior vitreous because of gravitational pull. An immunohistochemical study of snowbanks showed the presence of cytokeratin-positive retinal pigment epithelial cells on the uveal side and an absence of cells elsewhere.89 T lymphocytes were also demonstrated to be predominant in both vitreous and pars plana infiltrations.88 Vitreous snowballs have been reported to be present in up to 100% of affected eyes.35,77,90 Pars planitis may also present with peripheral retinal vascular sheathing and non-perfusion, but should not have retinal vascular occlusion in the posterior pole or mid-periphery.87
Comparison of pediatric patients with noninfectious idiopathic uveitis and noninfectious uveitis associated with an underlying systemic disease: from a referral center in Turkey
Published in Postgraduate Medicine, 2021
Semanur Ozdel, Esra Baglan, Tulin Gungor, Fatma Yazılıtas, Evrim Kargın Cakıcı, Pınar Cakar Ozdal, Mehmet Bulbul
Sixty-seven patients (66.3%) had idiopathic uveitis, 26 (25.7%) had juvenile idiopathic arthritis (JIA), 4 (4.0%) had tubulointerstitial nephritis and uveitis (TINU) syndrome, two (2.0%) had Behcet disease (BD), one patient (1.0%) had familial Mediterranean fever (FMF), and one patient (1.0%) Vogt-Koyanagi-Harada (VKH) syndrome. Among the patients, 67 (66.3%) were in group 1 (idiopathic uveitis), and 34 (33.7%) were in group 2 (noninfectious uveitis associated with an underlying systemic disease). JIA was the most common underlying systemic disease in group 2 (26/34 [76.4%]), followed by TINU syndrome (4/34; [11.7%]). Among the group 2 patients with JIA, 14 (53.8%) had oligoarticular JIA (11 persistent and 3 extended oligoarticular JIA), 7 had polyarticular JIA, and 5 had enthesitis-associated arthritis (ERA). Pars planitis was found to be in 13 patients (12.8%).
Differential Diagnosis of Vitritis in Adult Patients
Published in Ocular Immunology and Inflammation, 2021
Sarah Touhami, Mathilde Leclercq, Dinu Stanescu-Segall, Valérie Touitou, Bahram Bodaghi
The diagnosis of pars planitis is a diagnosis of exclusion and warrants performing a series of tests to exclude specific causes, especially infectious ones. A complete blood count with differential, angiotensin converting enzyme (ACE), lysozyme, serum and urinary calcium (to rule out sarcoidosis), serologies for infectious diseases including syphilis, lyme disease, cat-scratch disease, toxoplasmosis and toxocariasis are usually ordered. In endemic areas testing for HTLV 1 (human T cell leukemia/lymphoma virus type 1) infection may be useful.7,48 Chest computed tomography (or X-ray) scan is useful to rule out tuberculosis and sarcoidosis. Brain MRI is usually performed to rule out demyelinating pathologies such as multiple sclerosis (MS). It is worth mentioning that it might be necessary to repeat this exam because IU may precede the first neurological manifestations of MS. An anterior chamber tap, dosing interleukin 10 in the aqueous humor should be performed in patients aged over 50 years for which the diagnosis of primary intraocular lymphoma is contemplated.49,50 Vitreous biopsy, preferentially by means of pars plana vitrectomy may be necessary to confirm the diagnosis in highly suspicious case.49,50 An anterior chamber tap in patients with suspected Fuchs related vitritis may lead to the diagnosis of cytomegalovirus (CMV) or rubella infection.51