金台診所醫學美容的部落格

Posterior Uveitis; Pandora's box

Let me start by this question; Is posterior uveitis management within the domain of the general ophthalmologist? NO

1)many practitioners miss posterior uveitis altogether because they MISS looking at vitreous cells and a true posterior uveitis will not give anterior segment findings; LOOK for vitreous cells in every dilated fundus. Look DOWN in the inferior vitreous.

2)many of the signs of posterior uveitis are SUBTLE; vascular leaks, faint infiltrates, macular edema, mild disc swelling.

3)what is essential for the general ophthalmologist is to recognize infectious uveitis in order not to start steroids before giving the appropriate antibiotics.

4)When to suspect acute infectious posterior uveitis
-any acute uveitis starting above the age of 50
-any history of intraocular surgery even if remote
-any recent invasive procedure as cannulation or catheterization
-acute uveitis with vision drop out of proportion to the degree of vitritis in the absence of macular lesion
-immunosuppression
-persistent uveitis with history of reasonable dose of steroids

5)chronic infections must be excluded in all chronic uveitis particularly TB and Syphilis when suspected

6)the most practical way to classify posterior uveitis is
-vitritis with NO retinal lesion; suspect infection above 50 and in poorly controlled diabetics, Behçet's below 30, pars planitis 30-40, small cell lymphoma above 60
-unifocal lesion; heavy vitritis--Toxoplasmosis until proved otherwise, TB if chronic with mild vitritis; Toxocara in children
-multifocal; acute minimal vitritis--Harrada until proved otherwise, moderate vitritis; sarcoidosis, TB, Syphilis, idiopathic multifocal choroiditis, chronic no vitreous cells--PIC
-diffuse; retinal---Behçet's or ARN, deep---PORN in AIDS


By Dr.Hala AbdulwahabThe classification of unifocal, multifocal, diffuse is based on clinical examination or ffa primarily, Sir? Dr. Gehad Elnahri

By Dr.Gehad ElnahriClinical