Intermediate uveitis is an intraocular
inflammation involving the anterior vitreous, peripheral retina and pars plana. It usually affects patients from 5 to 30 years old, without gender or racial preferences. The etiology is unknown but there are several associated diseases:
multiple sclerosis, idiopathic
optic neuritis, autoimmune corneal endotheliopathy,
sarcoidosis,
thyroid diseases and
inflammatory bowel diseases. Symptoms are blurry vision, floaters and distortion of central vision. The syndrome is bilateral in 80% of the patients and chronic with periods of exacerbation and remission. Clinical presentation includes: 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,"
retinal "snowbanking,"
optic neuritis and
cystoid macular edema.
Cataract and
glaucoma are frequent complications. Treatment of
intermediate uveitis is based on periocular and oral
corticosteroids.
Cryotherapy or
laser photocoagulation of the peripheral retina are options in patients with snowbanking when there is an insufficient response to periocular or systemic
corticosteroids. Imunosuppression may also be used when other
therapies fail, and
Cyclosporin A is the first
drug of choice. Pars plana
vitrectomy is indicated in patients with chronic significant
inflammation, non-responsive
cystoid macular edema, non-clearing
vitreous hemorrhage, tractional
retinal detachment and
epiretinal membranes. The long-term prognosis of
intermediate uveitis is usually good, particularly with strict control of
inflammation and with proper management of complications. Patients can often maintain a vision of 20/50 or better.