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TITLE
bull Intrermediate Uveitis
bull Dr Md Mominul Islam
bull Fellow (Vitreo-Retina)
bull Ispahani Islamia Eye Institute And Hospital Dhaka
bull Bangladesh
INTRODUCTION
bull According to Standardized UveitisNomenclature Working Group
ldquoIntraocular inflammation in which the primary site is the vitreous but commonly involves the
peripheral retina as wellrdquo
EPIDEMIOLOGY AND DEMOGRAPHY
Prevalence 40 per 100thinsp000 persons 33 per 100thinsp000 persons
Incidence 15 per 100thinsp000 person-years 208 per 100thinsp000 persons
At any age (average 31 years more in younger)No gender and racial predilection
Thorne and colleagues- more common in women (664)
Dev Ophthalmol 2010 47136-147
PRESENTATION amp CLINICAL FINDINGS
bull Typically bilateral (745ndash80 bilateral)
bull Asymmetric unilaterally
bull Blurry vision and floaters
bull Pain
bull Redness
bull photophobia
Anterior vitreous cells
Diffuse vitreous haze
Snowballs
Snowbanks
Peripheral vasculitis
manifested by
perivascular sheathing
Differential diagnosis of intermediate uveitis
Infectious
bull Lyme disease
bull Syphilis
bull Toxocariasis
bull Toxoplasmosis
bull Tuberculosis
Immune
bull Idiopathic (nearly 70)
bull Pars planitis (36)
bull Sarcoidosis (222)
bull Multiple sclerosis (8)
Masquerade
bull Lymphoma (usually B-cell NHL)
bull Leukemia
bull Amyloidosis
bull Neoplasms
bull IrvinendashGass syndrome
Treatment
Unilateral disease
ActiveCMEInactiveminimally with smolding CME
Topcal corticosteroid and NSAIDs
Good respons
Posterior subtenonkenalog
after 3-4 weeks
Good response
Frequent 3 per year
PSTK
Minimum response
PSTK 1st
Good response
Repeat PSTKIVTA
When active
Flucinolone acetonide Implant Dexamethason intravitreal insert
NoMinimum
PSTKIVTA 2nd
Snowbank + Snowbank -
Cryotherapy Vitrectomy
If recurrence Systemic corticosteroid
Bilateral diseases
Prednisone 1 mgkgday
Good response
After 2 weeks at maximum doseTaper by 10mgweek until 20mg
Then 15 mg Thentaper by 25 mg increments
Minimum effective dose lt 5 mg daily
Prednisone
Minimum effective dose lt 5 mg daily
Prednisone
Prednisone 1 mgkgday
MinimumNo response
Good response
Mithotraxate 15-25 mg weekly +Folic acid 1 mg daily
Minimum effective dose lt 5 mg daily Prednisone
MinimumNo response
Azathioprine 50-250 mg PO DailyMycophenolate mofetil 500-
1500mg PO BID
Cytotoxicagent or T cell
inhbitor
Biologic (TNF ndashalpha or IL-2)
MinimumNo
response
Consider vitrectomy
Ophthalmology 1999 Jan106(1)111-8
Methotrexate treatment for sarcoidosisassociated panuveitis
Dev S McCallum RM Jaffe GJ
Source Department of Ophthalmology Duke University Medical Center Durham North Carolina USA
CONCLUSION
Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis
Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammationGalor A Jabs DA Leder HA Kedhar SR Dunn JP Peters GB 3rd Thorne JE
Source
Department of Ophthalmology the Johns Hopkins University School of Medicine Baltimore Maryland USA
Conclusions
These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2
agents
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
INTRODUCTION
bull According to Standardized UveitisNomenclature Working Group
ldquoIntraocular inflammation in which the primary site is the vitreous but commonly involves the
peripheral retina as wellrdquo
EPIDEMIOLOGY AND DEMOGRAPHY
Prevalence 40 per 100thinsp000 persons 33 per 100thinsp000 persons
Incidence 15 per 100thinsp000 person-years 208 per 100thinsp000 persons
At any age (average 31 years more in younger)No gender and racial predilection
Thorne and colleagues- more common in women (664)
Dev Ophthalmol 2010 47136-147
PRESENTATION amp CLINICAL FINDINGS
bull Typically bilateral (745ndash80 bilateral)
bull Asymmetric unilaterally
bull Blurry vision and floaters
bull Pain
bull Redness
bull photophobia
Anterior vitreous cells
Diffuse vitreous haze
Snowballs
Snowbanks
Peripheral vasculitis
manifested by
perivascular sheathing
Differential diagnosis of intermediate uveitis
Infectious
bull Lyme disease
bull Syphilis
bull Toxocariasis
bull Toxoplasmosis
bull Tuberculosis
Immune
bull Idiopathic (nearly 70)
bull Pars planitis (36)
bull Sarcoidosis (222)
bull Multiple sclerosis (8)
Masquerade
bull Lymphoma (usually B-cell NHL)
bull Leukemia
bull Amyloidosis
bull Neoplasms
bull IrvinendashGass syndrome
Treatment
Unilateral disease
ActiveCMEInactiveminimally with smolding CME
Topcal corticosteroid and NSAIDs
Good respons
Posterior subtenonkenalog
after 3-4 weeks
Good response
Frequent 3 per year
PSTK
Minimum response
PSTK 1st
Good response
Repeat PSTKIVTA
When active
Flucinolone acetonide Implant Dexamethason intravitreal insert
NoMinimum
PSTKIVTA 2nd
Snowbank + Snowbank -
Cryotherapy Vitrectomy
If recurrence Systemic corticosteroid
Bilateral diseases
Prednisone 1 mgkgday
Good response
After 2 weeks at maximum doseTaper by 10mgweek until 20mg
Then 15 mg Thentaper by 25 mg increments
Minimum effective dose lt 5 mg daily
Prednisone
Minimum effective dose lt 5 mg daily
Prednisone
Prednisone 1 mgkgday
MinimumNo response
Good response
Mithotraxate 15-25 mg weekly +Folic acid 1 mg daily
Minimum effective dose lt 5 mg daily Prednisone
MinimumNo response
Azathioprine 50-250 mg PO DailyMycophenolate mofetil 500-
1500mg PO BID
Cytotoxicagent or T cell
inhbitor
Biologic (TNF ndashalpha or IL-2)
MinimumNo
response
Consider vitrectomy
Ophthalmology 1999 Jan106(1)111-8
Methotrexate treatment for sarcoidosisassociated panuveitis
Dev S McCallum RM Jaffe GJ
Source Department of Ophthalmology Duke University Medical Center Durham North Carolina USA
CONCLUSION
Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis
Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammationGalor A Jabs DA Leder HA Kedhar SR Dunn JP Peters GB 3rd Thorne JE
Source
Department of Ophthalmology the Johns Hopkins University School of Medicine Baltimore Maryland USA
Conclusions
These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2
agents
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
EPIDEMIOLOGY AND DEMOGRAPHY
Prevalence 40 per 100thinsp000 persons 33 per 100thinsp000 persons
Incidence 15 per 100thinsp000 person-years 208 per 100thinsp000 persons
At any age (average 31 years more in younger)No gender and racial predilection
Thorne and colleagues- more common in women (664)
Dev Ophthalmol 2010 47136-147
PRESENTATION amp CLINICAL FINDINGS
bull Typically bilateral (745ndash80 bilateral)
bull Asymmetric unilaterally
bull Blurry vision and floaters
bull Pain
bull Redness
bull photophobia
Anterior vitreous cells
Diffuse vitreous haze
Snowballs
Snowbanks
Peripheral vasculitis
manifested by
perivascular sheathing
Differential diagnosis of intermediate uveitis
Infectious
bull Lyme disease
bull Syphilis
bull Toxocariasis
bull Toxoplasmosis
bull Tuberculosis
Immune
bull Idiopathic (nearly 70)
bull Pars planitis (36)
bull Sarcoidosis (222)
bull Multiple sclerosis (8)
Masquerade
bull Lymphoma (usually B-cell NHL)
bull Leukemia
bull Amyloidosis
bull Neoplasms
bull IrvinendashGass syndrome
Treatment
Unilateral disease
ActiveCMEInactiveminimally with smolding CME
Topcal corticosteroid and NSAIDs
Good respons
Posterior subtenonkenalog
after 3-4 weeks
Good response
Frequent 3 per year
PSTK
Minimum response
PSTK 1st
Good response
Repeat PSTKIVTA
When active
Flucinolone acetonide Implant Dexamethason intravitreal insert
NoMinimum
PSTKIVTA 2nd
Snowbank + Snowbank -
Cryotherapy Vitrectomy
If recurrence Systemic corticosteroid
Bilateral diseases
Prednisone 1 mgkgday
Good response
After 2 weeks at maximum doseTaper by 10mgweek until 20mg
Then 15 mg Thentaper by 25 mg increments
Minimum effective dose lt 5 mg daily
Prednisone
Minimum effective dose lt 5 mg daily
Prednisone
Prednisone 1 mgkgday
MinimumNo response
Good response
Mithotraxate 15-25 mg weekly +Folic acid 1 mg daily
Minimum effective dose lt 5 mg daily Prednisone
MinimumNo response
Azathioprine 50-250 mg PO DailyMycophenolate mofetil 500-
1500mg PO BID
Cytotoxicagent or T cell
inhbitor
Biologic (TNF ndashalpha or IL-2)
MinimumNo
response
Consider vitrectomy
Ophthalmology 1999 Jan106(1)111-8
Methotrexate treatment for sarcoidosisassociated panuveitis
Dev S McCallum RM Jaffe GJ
Source Department of Ophthalmology Duke University Medical Center Durham North Carolina USA
CONCLUSION
Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis
Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammationGalor A Jabs DA Leder HA Kedhar SR Dunn JP Peters GB 3rd Thorne JE
Source
Department of Ophthalmology the Johns Hopkins University School of Medicine Baltimore Maryland USA
Conclusions
These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2
agents
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
PRESENTATION amp CLINICAL FINDINGS
bull Typically bilateral (745ndash80 bilateral)
bull Asymmetric unilaterally
bull Blurry vision and floaters
bull Pain
bull Redness
bull photophobia
Anterior vitreous cells
Diffuse vitreous haze
Snowballs
Snowbanks
Peripheral vasculitis
manifested by
perivascular sheathing
Differential diagnosis of intermediate uveitis
Infectious
bull Lyme disease
bull Syphilis
bull Toxocariasis
bull Toxoplasmosis
bull Tuberculosis
Immune
bull Idiopathic (nearly 70)
bull Pars planitis (36)
bull Sarcoidosis (222)
bull Multiple sclerosis (8)
Masquerade
bull Lymphoma (usually B-cell NHL)
bull Leukemia
bull Amyloidosis
bull Neoplasms
bull IrvinendashGass syndrome
Treatment
Unilateral disease
ActiveCMEInactiveminimally with smolding CME
Topcal corticosteroid and NSAIDs
Good respons
Posterior subtenonkenalog
after 3-4 weeks
Good response
Frequent 3 per year
PSTK
Minimum response
PSTK 1st
Good response
Repeat PSTKIVTA
When active
Flucinolone acetonide Implant Dexamethason intravitreal insert
NoMinimum
PSTKIVTA 2nd
Snowbank + Snowbank -
Cryotherapy Vitrectomy
If recurrence Systemic corticosteroid
Bilateral diseases
Prednisone 1 mgkgday
Good response
After 2 weeks at maximum doseTaper by 10mgweek until 20mg
Then 15 mg Thentaper by 25 mg increments
Minimum effective dose lt 5 mg daily
Prednisone
Minimum effective dose lt 5 mg daily
Prednisone
Prednisone 1 mgkgday
MinimumNo response
Good response
Mithotraxate 15-25 mg weekly +Folic acid 1 mg daily
Minimum effective dose lt 5 mg daily Prednisone
MinimumNo response
Azathioprine 50-250 mg PO DailyMycophenolate mofetil 500-
1500mg PO BID
Cytotoxicagent or T cell
inhbitor
Biologic (TNF ndashalpha or IL-2)
MinimumNo
response
Consider vitrectomy
Ophthalmology 1999 Jan106(1)111-8
Methotrexate treatment for sarcoidosisassociated panuveitis
Dev S McCallum RM Jaffe GJ
Source Department of Ophthalmology Duke University Medical Center Durham North Carolina USA
CONCLUSION
Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis
Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammationGalor A Jabs DA Leder HA Kedhar SR Dunn JP Peters GB 3rd Thorne JE
Source
Department of Ophthalmology the Johns Hopkins University School of Medicine Baltimore Maryland USA
Conclusions
These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2
agents
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
Differential diagnosis of intermediate uveitis
Infectious
bull Lyme disease
bull Syphilis
bull Toxocariasis
bull Toxoplasmosis
bull Tuberculosis
Immune
bull Idiopathic (nearly 70)
bull Pars planitis (36)
bull Sarcoidosis (222)
bull Multiple sclerosis (8)
Masquerade
bull Lymphoma (usually B-cell NHL)
bull Leukemia
bull Amyloidosis
bull Neoplasms
bull IrvinendashGass syndrome
Treatment
Unilateral disease
ActiveCMEInactiveminimally with smolding CME
Topcal corticosteroid and NSAIDs
Good respons
Posterior subtenonkenalog
after 3-4 weeks
Good response
Frequent 3 per year
PSTK
Minimum response
PSTK 1st
Good response
Repeat PSTKIVTA
When active
Flucinolone acetonide Implant Dexamethason intravitreal insert
NoMinimum
PSTKIVTA 2nd
Snowbank + Snowbank -
Cryotherapy Vitrectomy
If recurrence Systemic corticosteroid
Bilateral diseases
Prednisone 1 mgkgday
Good response
After 2 weeks at maximum doseTaper by 10mgweek until 20mg
Then 15 mg Thentaper by 25 mg increments
Minimum effective dose lt 5 mg daily
Prednisone
Minimum effective dose lt 5 mg daily
Prednisone
Prednisone 1 mgkgday
MinimumNo response
Good response
Mithotraxate 15-25 mg weekly +Folic acid 1 mg daily
Minimum effective dose lt 5 mg daily Prednisone
MinimumNo response
Azathioprine 50-250 mg PO DailyMycophenolate mofetil 500-
1500mg PO BID
Cytotoxicagent or T cell
inhbitor
Biologic (TNF ndashalpha or IL-2)
MinimumNo
response
Consider vitrectomy
Ophthalmology 1999 Jan106(1)111-8
Methotrexate treatment for sarcoidosisassociated panuveitis
Dev S McCallum RM Jaffe GJ
Source Department of Ophthalmology Duke University Medical Center Durham North Carolina USA
CONCLUSION
Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis
Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammationGalor A Jabs DA Leder HA Kedhar SR Dunn JP Peters GB 3rd Thorne JE
Source
Department of Ophthalmology the Johns Hopkins University School of Medicine Baltimore Maryland USA
Conclusions
These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2
agents
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
Masquerade
bull Lymphoma (usually B-cell NHL)
bull Leukemia
bull Amyloidosis
bull Neoplasms
bull IrvinendashGass syndrome
Treatment
Unilateral disease
ActiveCMEInactiveminimally with smolding CME
Topcal corticosteroid and NSAIDs
Good respons
Posterior subtenonkenalog
after 3-4 weeks
Good response
Frequent 3 per year
PSTK
Minimum response
PSTK 1st
Good response
Repeat PSTKIVTA
When active
Flucinolone acetonide Implant Dexamethason intravitreal insert
NoMinimum
PSTKIVTA 2nd
Snowbank + Snowbank -
Cryotherapy Vitrectomy
If recurrence Systemic corticosteroid
Bilateral diseases
Prednisone 1 mgkgday
Good response
After 2 weeks at maximum doseTaper by 10mgweek until 20mg
Then 15 mg Thentaper by 25 mg increments
Minimum effective dose lt 5 mg daily
Prednisone
Minimum effective dose lt 5 mg daily
Prednisone
Prednisone 1 mgkgday
MinimumNo response
Good response
Mithotraxate 15-25 mg weekly +Folic acid 1 mg daily
Minimum effective dose lt 5 mg daily Prednisone
MinimumNo response
Azathioprine 50-250 mg PO DailyMycophenolate mofetil 500-
1500mg PO BID
Cytotoxicagent or T cell
inhbitor
Biologic (TNF ndashalpha or IL-2)
MinimumNo
response
Consider vitrectomy
Ophthalmology 1999 Jan106(1)111-8
Methotrexate treatment for sarcoidosisassociated panuveitis
Dev S McCallum RM Jaffe GJ
Source Department of Ophthalmology Duke University Medical Center Durham North Carolina USA
CONCLUSION
Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis
Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammationGalor A Jabs DA Leder HA Kedhar SR Dunn JP Peters GB 3rd Thorne JE
Source
Department of Ophthalmology the Johns Hopkins University School of Medicine Baltimore Maryland USA
Conclusions
These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2
agents
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
Treatment
Unilateral disease
ActiveCMEInactiveminimally with smolding CME
Topcal corticosteroid and NSAIDs
Good respons
Posterior subtenonkenalog
after 3-4 weeks
Good response
Frequent 3 per year
PSTK
Minimum response
PSTK 1st
Good response
Repeat PSTKIVTA
When active
Flucinolone acetonide Implant Dexamethason intravitreal insert
NoMinimum
PSTKIVTA 2nd
Snowbank + Snowbank -
Cryotherapy Vitrectomy
If recurrence Systemic corticosteroid
Bilateral diseases
Prednisone 1 mgkgday
Good response
After 2 weeks at maximum doseTaper by 10mgweek until 20mg
Then 15 mg Thentaper by 25 mg increments
Minimum effective dose lt 5 mg daily
Prednisone
Minimum effective dose lt 5 mg daily
Prednisone
Prednisone 1 mgkgday
MinimumNo response
Good response
Mithotraxate 15-25 mg weekly +Folic acid 1 mg daily
Minimum effective dose lt 5 mg daily Prednisone
MinimumNo response
Azathioprine 50-250 mg PO DailyMycophenolate mofetil 500-
1500mg PO BID
Cytotoxicagent or T cell
inhbitor
Biologic (TNF ndashalpha or IL-2)
MinimumNo
response
Consider vitrectomy
Ophthalmology 1999 Jan106(1)111-8
Methotrexate treatment for sarcoidosisassociated panuveitis
Dev S McCallum RM Jaffe GJ
Source Department of Ophthalmology Duke University Medical Center Durham North Carolina USA
CONCLUSION
Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis
Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammationGalor A Jabs DA Leder HA Kedhar SR Dunn JP Peters GB 3rd Thorne JE
Source
Department of Ophthalmology the Johns Hopkins University School of Medicine Baltimore Maryland USA
Conclusions
These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2
agents
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
after 3-4 weeks
Good response
Frequent 3 per year
PSTK
Minimum response
PSTK 1st
Good response
Repeat PSTKIVTA
When active
Flucinolone acetonide Implant Dexamethason intravitreal insert
NoMinimum
PSTKIVTA 2nd
Snowbank + Snowbank -
Cryotherapy Vitrectomy
If recurrence Systemic corticosteroid
Bilateral diseases
Prednisone 1 mgkgday
Good response
After 2 weeks at maximum doseTaper by 10mgweek until 20mg
Then 15 mg Thentaper by 25 mg increments
Minimum effective dose lt 5 mg daily
Prednisone
Minimum effective dose lt 5 mg daily
Prednisone
Prednisone 1 mgkgday
MinimumNo response
Good response
Mithotraxate 15-25 mg weekly +Folic acid 1 mg daily
Minimum effective dose lt 5 mg daily Prednisone
MinimumNo response
Azathioprine 50-250 mg PO DailyMycophenolate mofetil 500-
1500mg PO BID
Cytotoxicagent or T cell
inhbitor
Biologic (TNF ndashalpha or IL-2)
MinimumNo
response
Consider vitrectomy
Ophthalmology 1999 Jan106(1)111-8
Methotrexate treatment for sarcoidosisassociated panuveitis
Dev S McCallum RM Jaffe GJ
Source Department of Ophthalmology Duke University Medical Center Durham North Carolina USA
CONCLUSION
Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis
Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammationGalor A Jabs DA Leder HA Kedhar SR Dunn JP Peters GB 3rd Thorne JE
Source
Department of Ophthalmology the Johns Hopkins University School of Medicine Baltimore Maryland USA
Conclusions
These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2
agents
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
Bilateral diseases
Prednisone 1 mgkgday
Good response
After 2 weeks at maximum doseTaper by 10mgweek until 20mg
Then 15 mg Thentaper by 25 mg increments
Minimum effective dose lt 5 mg daily
Prednisone
Minimum effective dose lt 5 mg daily
Prednisone
Prednisone 1 mgkgday
MinimumNo response
Good response
Mithotraxate 15-25 mg weekly +Folic acid 1 mg daily
Minimum effective dose lt 5 mg daily Prednisone
MinimumNo response
Azathioprine 50-250 mg PO DailyMycophenolate mofetil 500-
1500mg PO BID
Cytotoxicagent or T cell
inhbitor
Biologic (TNF ndashalpha or IL-2)
MinimumNo
response
Consider vitrectomy
Ophthalmology 1999 Jan106(1)111-8
Methotrexate treatment for sarcoidosisassociated panuveitis
Dev S McCallum RM Jaffe GJ
Source Department of Ophthalmology Duke University Medical Center Durham North Carolina USA
CONCLUSION
Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis
Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammationGalor A Jabs DA Leder HA Kedhar SR Dunn JP Peters GB 3rd Thorne JE
Source
Department of Ophthalmology the Johns Hopkins University School of Medicine Baltimore Maryland USA
Conclusions
These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2
agents
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
Prednisone 1 mgkgday
MinimumNo response
Good response
Mithotraxate 15-25 mg weekly +Folic acid 1 mg daily
Minimum effective dose lt 5 mg daily Prednisone
MinimumNo response
Azathioprine 50-250 mg PO DailyMycophenolate mofetil 500-
1500mg PO BID
Cytotoxicagent or T cell
inhbitor
Biologic (TNF ndashalpha or IL-2)
MinimumNo
response
Consider vitrectomy
Ophthalmology 1999 Jan106(1)111-8
Methotrexate treatment for sarcoidosisassociated panuveitis
Dev S McCallum RM Jaffe GJ
Source Department of Ophthalmology Duke University Medical Center Durham North Carolina USA
CONCLUSION
Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis
Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammationGalor A Jabs DA Leder HA Kedhar SR Dunn JP Peters GB 3rd Thorne JE
Source
Department of Ophthalmology the Johns Hopkins University School of Medicine Baltimore Maryland USA
Conclusions
These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2
agents
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
Ophthalmology 1999 Jan106(1)111-8
Methotrexate treatment for sarcoidosisassociated panuveitis
Dev S McCallum RM Jaffe GJ
Source Department of Ophthalmology Duke University Medical Center Durham North Carolina USA
CONCLUSION
Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis
Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammationGalor A Jabs DA Leder HA Kedhar SR Dunn JP Peters GB 3rd Thorne JE
Source
Department of Ophthalmology the Johns Hopkins University School of Medicine Baltimore Maryland USA
Conclusions
These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2
agents
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammationGalor A Jabs DA Leder HA Kedhar SR Dunn JP Peters GB 3rd Thorne JE
Source
Department of Ophthalmology the Johns Hopkins University School of Medicine Baltimore Maryland USA
Conclusions
These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2
agents
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
VITRECTOMY
bull Therapeutic
a No responsive to standard medical therapy
bull Diagnostic
a Specimen sent for cytopathological evaluation andor flow cytometry
Herpetic viral infection
Toxoplasma
Intraocular lymphoma
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often ndash Favorable
Mean visual acuity after 10 years of follow up-2030
75 maintained VA or ndash 2040 or better
One third maintained VA ndash Normal without treatment
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy
COMPLCATIONS
bull Vision loss due to CME ndash 412 over 15 years amp 457
Uveitic Glaucoma
Retinal detachment
Vitreous haemorrhage
Cataracts ndash 342
Epiretinal membrane 444
Band Keratopathy