Posterior Uveitis

Question 1

When you are dealing with intermediate uveitis, how do you determine the method of treatment?

Answer 1

1. Consider the amount of vitreous cells present, VA, and presence/absence of CME.

If mild to moderate vitreous cells, VA >20/30, no CME, you observe the uveitis without treatment.

If severe vitreous cells, VA <20/40, CME present, treat with systemic steroids or sub-Tenon’s injection. If that doesn’t help, consider the following in this order: cryopexy of the pars plana, pars plana vitrectomy, immunosuppressive therapy

Question 2

What should be included in an initial work-up in patients with the following when they present with a negative family history.

1. Intermediate Uveitis
2. Posterior Uveitis or posterior segment involvement
3. Retinal Vasculitis

Answer 2

1. Intermediate Uveitis: 
ACE - Sarcoid
Lyme Titers & Western Blot - Lyme Disease 
FTA - ABS - Syphillis 
Toxocara Titers - Toxocariasis
Cat Scratch Titers - B. Hensle 
MRI - MS 

2. Posterior Uveitis or Posterior Segment Involvement:
   CBC with differential
   ESR - If faster than normal -> inflammation
   Soluble IL-2 receptor
   Toxoplasma titers - Toxoplasmosis

3. Retinal Vasculitis
CBC with differential 
ESR
Soluble IL-2 receptor - T cells 
Raji Cell Assay - circulating immune complex
C1Q Binding immune complex assay

Question 3

1. What is intermediate uveitis also known as?
2. Is intermediate uveitis bilateral or unilateral?
3. What are some ocular manifestations of intermediate uveitis?
4. What are the most common complications of intermediate uveitis?

Answer 3

1. Pars Planitis, Cyclitis, Peripheral cyclitis, etc
2. Bilateral 80% of time
3. Ocular manifestations:
   Minimal AC reaction
   pain/photophobia ABSENT
   Snowballs in vitreous & snow banking over pars plana
4. Common complications:
   cataracts and CME

Question 4

What percent of pediatric uveitis is intermediate uveitis?

Answer 4

16-30%

Question 5

How do you treat intermediate uveitis?

Answer 5

Topical or sub-Tenon injection of steroids only if VA is worse than 20/40, CME is present, or severe vitreal inflammation present

Question 6

What are some common ocular manifestations for toxoplasmosis?

Answer 6

Floaters and decreased vision
Focal areas of retinochoroiditis
Quiet eye with no anterior segment inflammation

Question 7

What lab tests are ordered to confirm/deny the presence of toxoplasmosis?

Answer 7

ELISA - Checking for antibodies
IgM titer
Skull X-Rays

Question 8

What is the description of the fundus when discussing toxoplasmosis?

Answer 8

Headlights in a fog. WBC accumulation makes it hard to view the retina. The optic nerve is seen as one headlight and a granuloma is seen as the other.

Question 9

What two posterior uveitic diseases will exhibit reactivation as a satalite lesion at the edge of a previous lesion?

Answer 9

Toxoplasmosis
Geographic (Serpiginous) Choroidopathy

Question 10

Is Toxocariasis unilateral or bilateral?

Answer 10

Unilateral

Question 11

What are the possible presentations of toxocariasis?

Answer 11

1. Endophthalmitis: Inflammation of ocular fluid (vitreous/aqueous)
   Anterior chamber reaction present
2. Posterior Pole Granuloma:
   Traction band pulling retina towards the granuloma
   AC quiet
3. Peripheral Granuloma
   Traction band pulling retina towards the granuloma
   AC quiet

Question 12

What lab tests are run to confirm/deny the presence of toxocariasis?

Answer 12

ELISA
Paracentesis for eosinophils
Echography