UVEITIS AND CYSTOID MACULA OEDEMA Case 1.pdfUveitis can cause CMO New modalities of tid IVTA...
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CASE PRESENTATION 1 UVEITIS AND CYSTOID MACULA OEDEMA DR HANIZASURANA HASHIM DR HANIZASURANA HASHIM UVEITIS FELLOW MOORFIELDS EYE HOSPITAL
Transcript of UVEITIS AND CYSTOID MACULA OEDEMA Case 1.pdfUveitis can cause CMO New modalities of tid IVTA...
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
