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2.1
Intermediate Uveitis
Pars Planitis - Chronic Cyclitis

Presentation

Objectives: Identify the presenting features of pars planitis. Review the typical presentation of pars planitis. Summarize the treatment options for pars planitis. [statpearls.com]

Patients are frequently asymptomatic, but may present with moderately diminished vision that is slowly progressive, as well as complaints of floaters. [louisvillediabeticeyedoctor.com]

Although CM are not the most frequently observed complication of PP, they become a matter of concern when present; their presence may worsen the final visual prognosis. [joii-journal.springeropen.com]

To the author's knowledge this is the first case of familial pars planitis as the presenting sign of possible demyelinating disease. [tandfonline.com]

Results Median age at presentation was 8 years. 35 patients (71.4%) were male and 43 patients (87.7%) had bilateral disease. [bjo.bmj.com]

Eyes

  • Blurred Vision

    Symptoms of Pars Planitis Symptoms experienced by patients with the condition include: Blurred vision and dark floating spots that interfere with the clarity of eyesight. [somerseteyesurgeon.co.uk]

    The Humphrey ultrasound biomicroscope was used for examination of the right eye of a 17-year-old boy, referred to our clinic because of blurred vision. The lens showed a posterior subcapsular cataract precluding fundus visualization. [ncbi.nlm.nih.gov]

    In some cases, the disturbance of vision may be slightly progressive. Signs & Symptoms The symptoms of pars planitis include blurred vision and dark floating spots that intrude upon clarity of eyesight. [rarediseases.org]

  • Anterior Uveitis

    Topical steroids are employed only if there is a concomitant anterior uveitis. Oral prednisone is more commonly used. However, once a commitment to use oral steroids is made, typically they must be used for months. [louisvillediabeticeyedoctor.com]

    Pars planitis is considered a subset of intermediate uveitis (one of the 4 types of uveitis, namely, anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis) and is identified by the presence of white exudates over the pars plana. [somerseteyesurgeon.co.uk]

    Iritis (Anterior Uveitis) http://drstevenodrich.com/iritis-anterior-uveitis/ Iritis, also called “anterior uveitis” is an inflammatory disorder of the iris, the colored portion of the eye that surrounds the pupil. [rul.sarkatvolley.net]

    —Pars planitis is a form of anterior uveitis, the cause of which is not known. [jamanetwork.com]

    uveitis, uveitis anterior, Anterior uveitis (diagnosis), Anterior uveitis, NOS, Anterior uveitis [Ambiguous], Anterior uveitis (disorder), Anterior Uveitis Dutch voorste uveïtis, uveïtis anterior, Uveitis anterior German anteriore Uveitis, Uveitis anterior [fpnotebook.com]

  • Visual Impairment

    Visual acuity improved in all patients after treatment, with an average of 4 lines of improvement. Conclusions: : Pars planitis in pediatric patients may cause significant visual impairment, and its presentation may vary considerably. [iovs.arvojournals.org]

    Although a subset of patients with pars planitis do not have macular edema or visual impairment and may be observed, the majority of patients need treatment. [entokey.com]

    Complications Decreased Visual Acuity Severe Visual Impairment : 35% Legally blind: 10% Iris scarring Impaired pupillary movement Secondary Glaucoma XIII. [fpnotebook.com]

  • Progressive Loss of Vision

    This form is more difficult to treat, and is often associated with progressive loss of vision. Pan-uveitis - When inflammation affects all three areas of the uvea it is referred to as pan-uveitis. [bausch.com]

Workup

The diagnosis workup including blood work, MRI, and neurological exam were ordered; results, treatment, and prognosis for this case is discussed. [aaopt.org]

Although most pediatric IU cases are idiopathic, a systemic workup is recommended to evaluate for underlying disorders (see “Possible Etiologies”). [aao.org]

Systemic workup for conditions associated with intermediate uveitis including sarcoidosis evaluation was negative. [joii-journal.springeropen.com]

Signs of dermatitis may point to Lyme disease, tuberculosis, or syphilis, whereas arthritis of the knee may suggest the possibility of Lyme's, disease, and contact with cats may raise the possibility of Bartonella infection. [1] A routine baseline workup [ijo.in]

However, even with a full diagnostic workup, a large proportion of IU cases remain idiopathic. There are numerous causes of intermediate uveitis, and this makes its epidemiology difficult to evaluate. [morancore.utah.edu]

Treatment

The key to improving treatment outcomes for pars planitis is early and aggressive treatment. Because the disease can become chronic, your healthcare provider may recommend routine follow-up appointments to monitor your condition. [verywellhealth.com]

It can be a useful tool for the follow-up of these patients, and allows monitoring the response to treatment. [eyewiki.aao.org]

[…] respectively.[48] In our current practice, the first treatment step is the use of CS which is still the mainstay of treatment. [ncbi.nlm.nih.gov]

Prognosis

Visual potential and prognostic factors can also be determined by OCT: correlations have been shown between: vision and foveal thickness IS/OS junction abnormalities and poorer visual prognosis CMO with healthy IS/OS junction and better visual prognosis [eyewiki.aao.org]

Some authorities believe that patients with pars planitis have worse vitritis, more severe macular edema, and a guarded prognosis compared to other patients with intermediate uveitis. [wikidoc.org]

Prognosis The sooner you obtain a diagnosis of pars planitis and begin treatment, the better your chances of preventing permanent damage and making a full recovery. [verywellhealth.com]

PURPOSE: To measure the incidence of pars planitis in a community-based population and to report clinical features, complications, and visual prognosis. DESIGN: Population-based, retrospective, 20-year cohort study. [ncbi.nlm.nih.gov]

Etiology

The etiology of the antigenic stimulus is not clear and may be either vitreal or perivascular in nature. It is evident that genetics plays some role in the pathophysiology of intermediate uveitis, but the importance remains unclear. [wikidoc.org]

It is important to examine the area for neovascularization, which can be a source of vitreous hemorrhage. 2 Etiology. [aao.org]

Although the etiology of pars planitis remains obscure, clinical evidence suggests a strong association with multiple sclerosis. [mayoclinic.pure.elsevier.com]

Inflammatory etiologies include uveitis-glaucoma-hyphema syndrome, sympathetic ophthalmia, sarcoidosis, pars planitis, multiple sclerosis, rheumatoid arthritis, birdshot chorioretinopathy, Behcet disease, Vogt-Koyanagi-Harada disease, sterile endophthalmitis [medical-dictionary.thefreedictionary.com]

Update: 12/22/2002. 3pp. www.nlm.nih.gov/medlineplus/print/ency/article/001005.htm Pars Planitis: A Syndrome of Unknown Etiology or a Clinical Picture of Multiple Etiologies. [rarediseases.org]

Epidemiology

The immunogenetic association has been suggested by studies citing association of HLA-B51, HLA-DR2, HLA-DR15,[3] and HLA-DRB1*0802 haplotypes with pars planitis.[2] Epidemiology In a prospective epidemiology study of 215 uveitis patients, Vadot et al. [statpearls.com]

Pars planitis: epidemiology and clinical outcome in a large community hospital in Mexico city. [link.springer.com]

Pars Planitis: Epidemiology, Clinical Characteristics, Management and Visual Prognosis., Ozdal PC,Berker N,Tugal-Tutkun I,, Journal of ophthalmic & vision research, 2015 Oct-Dec [PubMed] Standardization of uveitis nomenclature for reporting clinical data [knowledge.statpearls.com]

Epidemiology IU is a rare disease, with an estimated incidence of 1.4-2.0 /100.000. The prevalence is estimated to be 5.9/100.000. However, the epidemiology of IU seems to have geographical differences, possibly due to different etiologies. [eyewiki.aao.org]

[…] immunosuppressive agents) found that while the steroid implant treatment possibly prevents the recurrence of uveitis, there may be adverse safety outcomes, such as the increased risk for needing cataract surgery and surgery to lower intraocular pressure.[1] Epidemiology [en.wikipedia.org]

Pathophysiology

It is evident that genetics plays some role in the pathophysiology of intermediate uveitis, but the importance remains unclear. [en.wikipedia.org]

• The pathophysiology of IU/pars planitis is not well understood – It is probably an autoimmune reaction against an ocular antigen • Peripheral retinal veins are the primary foci for inflammation COMMONLY ASSOCIATED CONDITIONS • Sarcoidosis • Multiple [entokey.com]

Here, we report a case of peripapillary CNV in a patient with intermediate uveitis and explore the pathophysiology and outcome of this condition. [joii-journal.springeropen.com]

[…] exists.[5] MS has been characterized into four different subtypes, which include relapsing/remitting, primary progressive, secondary progressive and relapsing progressive, depending on the time course and progression of neurologic disability.[6] The pathophysiology [medscape.com]

Prevention

In order to prevent these vision blinding complications patients need alternative therapies. What Causes Pars Planatis? The most common cause of Pars Planitis is idiopathic or autoimmune. [eyesurgeonsnyc.com]

Research comparing fluocinolone acetonide intravitreal implants to standard-of-care treatments (prednisolone with immunosuppressive agents) found that while the steroid implant treatment possibly prevents the recurrence of uveitis, there may be adverse [en.wikipedia.org]

Physical Examination Laboratory Findings Imaging Findings Other Diagnostic Studies Treatment Medical Therapy Surgery Prevention References Template:WikiDoc Sources [wikidoc.org]

Prevention Treatment of an underlying disorder may help to prevent uveitis in persons with a body-wide (systemic) infection or disease. Diagnosis A complete medical history and eye examination should be performed. [checkorphan.org]

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