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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