CASE PRESENTATION 1

UVEITIS AND CYSTOID MACULA OEDEMA

DR HANIZASURANA HASHIMDR HANIZASURANA HASHIMUVEITIS FELLOW

MOORFIELDS EYE HOSPITAL

43/ lady/ housewife PSH2001 OS ERM l ith Aug 2005- VR clinic

Blurring of vision OU x 2001 – OS ERM peel with gas2003 OS IOL

g4 yearsImage distortion OS

2003 – OS IOL

Image distortion OSNo systemic symptoms

PMHHigh cholesterol –pravastatin

Examination - 2005

Vision: 6/18 OU Fundus:

Anterior Chamber: quietIOP 12/13

Vitreous clear OUOD: NADIOP 12/13

OD: NS + OS: hazy view (PCO), ERMOS: IOL with PCO ERM

Y l t OSYag capsulotomy OSSchedule for Rt cataract removal

Pre op assessment

Oct 2005During Pre Op assessment, noted AC Referral to uveitis cliniccells + both eyes and vitritis + both eyes

Topical steroids

Postponed opPostponed op

Jan 2006 – Uveitis clinicJan 2006 Uveitis clinicFloaters > 20 yrs 1 episode of inflammation b th 20

Fundus: both eyes, 20 yrs ago - on topical steroids Vision 6/18 OU

OU: Vitritis +, snowballs+ OU: CMO OS ERMVision 6/18 OU

AC cells +/- OUOD: NS+

OS: ERM

OS: IOL+

Fundus

Fluorescein Angiogram0.18 0.30

11 i 12 i11 min 12 min

Diagnosis: Bilateral Intermediate Uveitis

Options: Local /Systemic

FBC/VDRL/CRP/ACE/ANOrbital floor - steroid

FBC/VDRL/CRP/ACE/ANCA/dsDNA/ANA/CXR -All normalAll normal

3 MONTHS LATER (Apr 2006)VA 6/18 OUVA 6/18 OUAC quiet, RE IVTA Vitreous clearOU: CMO +

LE IVTA - 2 weeks laterOU: CMO + OS: LE striation and ERMERM

June 2006VA: 6/9 OD 6/12 OSNo AC cellsNo active vitritisNo active vitritis

6/18 - Pre 6/9- post

Right Eye

10639376/18 Pre 6/9- post

6/18- Pre Left Eye

6/12 - post

OCTOD Apr 2006 OS Apr 2006

OD Jun 2006 OS Jun 2006

6/18 6/18

OD Jun 2006 OS Jun 2006

6/9 6/12

O t 2006 4 th l tOct 2006 – 4 months laterOD OSOD OS

6/18 6/183 months later After re-IVTAOD OS

6/12 6/126/12 6/12

Latest follow up in Mar 2008Mi i l i di t ti OSMinimal image distortion OSVA OD 6/12 and OS 6/9Q i t AC d it N i t ti d dQuiescent AC and vitreousOD: NS +

No intervention needed

OU: minimal CMOOS: ERM+No OCT

Conclusions:

Uveitis can cause CMO New modalities of t id

IVTA improves CMO in steroid:

- Dexamethasone puveitis in a short term (Posurdex)– 4-6 mo

- Fluocinolone acetonide Need to be repeated after 2 3 months

(Retisert) – 2 and ½ yrs2-3 months

Thank You