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MISCELLANEOUS ANTERIOR
AND POSTERIOR UVEITIS
Capt SHOAIB MUHAMMAD
FUCHS UVEITIS SYNDROME Fuch heterochromic iridocyclitis Chronic non-granulomatous specific
uveitis usually unilateral 90% 3rd – 4th decades M:F – 1:1 4% all cases of uveitis
Presentation Chronic annoying vitreous floatersGradual blurring of visionColour difference between two eyes Incidental detection
General signsAbsent posterior synechiaeKPSmall iris nodulesAC—faint flare,mild cellular reactionVitritis
FUCHS UVEITIS SYNDROME
Diffuse iris atrophyLoss of iris cryptsStromal atrophyPosterior pigment layer atrophy
Heterochromia iridisDetermined by
Degree of atrophy Natural iris colour
Hypochromia Reverse heterochromia
FUCHS UVEITIS SYNDROME
GonioscopyRadial twig like vesselsAmsler signPeripheral anterior synechiae
ComplicationsCataractGlaucoma
TreatmentPosterior sub tenon steroidsVitrecomy
FUCHS UVEITIS SYNDROME
LENS-INDUCED UVEITIS1. Phacoanaphylactic endophthalmitis
Presentation Days to weeks after rupture of lens capsule
Signs Granulomatous anterior uveitis Raised IOP
Differential diagnosis Bacterial endophthalmitis Prolonged
surgery Toxic reaction
Treatment Removal of lens matter Intensive steroid therapy
Phacogenic non-granulomatous uveitisSigns
Within 2-3 weeks of capsule rupture Less severe
Differential diagnosis Lowgrade bacterial and fungal endophthalmitis SO or IOL-induced inflammation
Treatment Mild – Topical steroids Intense inflammation- Periocular or systemic
steroids
LENS-INDUCED UVEITIS
ACUTE RETINAL PIGMENT EPITHELITIS (KRILL DISEASE) Presentation
3rd decadeSudden diminution of central vision
Signs 1 to 2 weeks after symptomsResolve 6 to 12 weeks
FFAHyperfluorscence without leakage
EOGSubnormal
Treatment
Differential diagnosis
Rubella retinitis
Acute macular neuroretinopathy
Punctate inner choroidopathy
Central serous retinochoroidopathy
ACUTE RETINAL PIGMENT EPITHELITIS (KRILL DISEASE)
ACUTE IDIOPATHIC MACULOPATHY Presentation
2nd to 4th decadeSudden severe loss of central vision
SignsRD at macula with irregular outline Intraretinal hemorrhages Iritis, papillitis and mild vitritisResolve with in few weeks
FFAEarly phase-mild hyperfluorescenceVenous phase-staining of SRF
Treatment
Differential diagnosis Idiopathic choroidal neovascularizationCentral serous chorioretinopathyVKH syndromeSerpiginous choroidopathyPosterior scleritisPlacoid syphilitic retinitisRPE detachmentAcute posterior multifocal placoid pigment
epitheliopathy
ACUTE IDIOPATHIC MACULOPATHY
ACUTE MULTIFOCAL RETINITIS Presentation
3rd to 4th decadeSudden onset mild visual loss
Signs Multiple areas of retinitisMild vitritis,disc edemaMacular starRecovery – 2-4 months
Treatment
SOLITARY IDIOPATHIC CHOROIDITIS/ UNIFOCAL HELOID CHOROIDITIS
PresentationMild visual loss and floaters
SignsDiscrete choroidal elevationsSRF and macular star
Treatment Active vision threatning-systemic steroids Inactive – resolve spontaneously
Differential diagnosis Inflammatory lesions
Sarcoid choroiditis Tuberculosis
Histoplasma choroiditisToxoplasma retinochoroiditisNodular posterior scleritisAmelanotic tumour e;g melanomaMetastasis
SOLITARY IDIOPATHIC CHOROIDITIS/ UNIFOCAL HELOID CHOROIDITIS
FROSTED BRANCH ANGIITIS (FBA) Primary FBA
Children and young adults Secondary FBA
Associated with infectious retinitis,CRVO Presentation
Sub acute visual loss Floaters and/or photopsia
Signs Florid translucent perivascular sheathing Anterior uveitis,vitritis and retinal edema
Treatment Systemic or topical steroids
THANK YOU
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