Intermediate Uveitis

Front 1

Name ten things in the differential diagnosis for intermediate uveitis?

Back 1

1) pars planitis
2) multiple sclerosis
3) Lyme disease
4) sarcoidosis
5) TB
6) syphilis
7) toxocariasis
8) primary Sjogren's disease
9) HTLV-1 infection
10) Masquerade syndrome

Front 2

What is the Standardization of Uveitis Nomenclature (SUN) working group's definition of intermediate uveitis?

Back 2

Major site of inflammation in the vitreous

Front 3

What is the most common cause of intermediate uveitis?

Back 3

Pars planitis (idiopathic) in 85-90%

Front 4

What are three signs of intermediate uveitis?

Back 4

1) vitritis
2) snowballs
3) snowbanking

Front 5

What are the two most common complication of pars planitis?

Back 5

1) CME (50%)
2) cataracts (15-60%)

Front 6

What are the more infrequent complications of pars planitis?

Back 6

1) Chronic recalcitrant CME (10%)
2) NVE/NVD (5-15%)
3) VH (<5%)
4) TRD/RRD (5-15%)
5) retrolental membranes
6) Glaucoma (10%)
7) ERM (5-10%)
8) visually significant floaters
9) Band Keratopathy
10) posterior synechiae

~10% for all

Front 7

What are the possible courses for patients with pars planitis?

Back 7

10% self-limited
30% relapsing and remitting
60% single chronic & prolonged episode

*usually burns out in 5-15 years

Front 8

What is the visual prognosis for patients with pars planitis?

Back 8

75% > 20/50 at 4 years

Front 9

What is the workup for patients with intermediate uveitis (IU)?

Back 9

Chest CT, Lyme titer and FTA-ABS

Front 10

What HLA subtype is associated with both pars planitis and multiple sclerosis?

Back 10

HLA-DR15

Front 11

What % of patients with MS will have IU?

Back 11

5-20%

Front 12

What % of sarcoidosis patients will have IU?

Back 12

7%

Front 13

What differentiates the vitritis of pars planitis from intraocular lymphoma?

Back 13

age:
lymphoma > 50
pars planitis 5-40

Front 14

What three features can differentiate Fuchs heterochromic iridocyclitis from pars planitis?

Back 14

1) iris heterochromia
2) diffuse stellate KP
3) unilateral disease

Front 15

Is pars planitis usually bilateral or unilateral?

Back 15

bilateral (80%)

Front 16

What are the two major causes of vision loss in pars planitis?

Back 16

1) chronic CME
2) cataracts

Front 17

What is the cause of pars planitis?

Back 17

Unknown but likely autoimmune (may be against nup36)

Front 18

What are the five possible retinal findings in pars planitis?

Back 18

1) peripheral periphlebitis
2) inferior deposit of inflammatory cells (snowbanking)
3) neovascularization
4) tractional, exudative or rhegmatogenous detachment
5) ERM

Front 19

What are the three possible vitreous findings in pars planitis?

Back 19

1) dense cell
2) vitreous opacities (snowballs)
3) vitreous hemorrhage (rare)

Front 20

Is pars planitis associated with AC cell?

Back 20

Yes, spill over from the vitreous (less dense)

Front 21

What is the treatment for pars planitis without CME?

Back 21

Watchful waiting

Front 22

What is the first-line therapy for pars planitis with CME?

Back 22

PST (posterior sub-Tenon's) Kenalog q4weeks x 4

Front 23

What is the next step in treatment of pars planitis if PST Kenalog therapy is unsuccessful?

Back 23

Can consider intravitreal or oral corticosteroids

Front 24

What is the treatment for CME-associated pars planitis which is refractory to all corticosteroids?

Back 24

Cryotherapy and peripheral scatter laser

Front 25

Is cryo or laser applied to the snowbank?

Back 25

No, both are applied to wall off the region
Cryo - double row 1 clock hour beyond disease
Laser - 3 to 4 rows posterior to the snowbank

Front 26

How does cryo or laser help pars planitis?

Back 26

Unknown, but FA shows marked decrease in peripheral leakage (from venules) after cryo

Front 27

What is the treatment for pars planitis which is refractory to both steroids and cryotherapy?

Back 27

PPV with PRP applied around the snowbank

Front 28

What are three indications for PPV in pars planitis?

Back 28

1) CME (unresponsive to steroids and cryo)
2) visually significant vitreous opacities (hemorrhage and inflammatory)
3) tractional or rhegmatogenous RD

Front 29

What is the last ditch therapy for pars planitis?

Back 29

systemic immunomodulators (e.g. MTX and cyclosporine)

Front 30

What are the two age groups characteristically affecting by pars planitis?

Back 30

5-15 and 20-40

Front 31

What are three characteristic findings on FA in patients with pars planitis?

Back 31

1) petalloid leakage (CME)
2) peripheral vascular leakage (periphlebitis)
3) disc leakage possible

Front 32

What is the B-scan finding in pars planitis?

Back 32

inferior membrane

Front 33

What are the three histologic findings in pars planitis?

Back 33

1) cuffing of venules with lymphocytes (periphlebitis)
2) fibrovascular membrane over the pars plana (snowbank)
3) condensation of mixed inflammatory cells (snowballs)

Front 34

What percentage of patients with multiple sclerosis will present first with intermediate uveitis?

Back 34

25%

Front 35

What percentage of patients initially diagnosed with pars planitis will eventually develop MS?

Back 35

15%

Front 36

Is the uveitis in MS associated with the systemic disease activity or optic neuritis?

Back 36

No

Front 37

What three features help differentiate the IU of MS from that of standard pars planitis?

Back 37

1) Less intense vitritis
2) Less CME
3) more female restriction (pars planitis affects men and women equally)

Front 38

What are the two most common uveitic syndromes in MS?

Back 38

1) IU
2) pan-uveitis

Front 39

What is the potential link between IU and MS?

Back 39

antibodies against myelin cross-react with Muller cells

Front 40

Pars planitis - if CME is present, inject PST Kenalog

Back 40

A ten year old girl presents with new floaters. The depressed exam inferiorly is shown above. Her laboratory and imaging work-up is negative. What would determine if she gets treated?

Front 41

Is the eye in pars planitis typically red or quiet?

Back 41

quiet