Intermediate uveitis is characterized by inflammation of the vitreous and peripheral retina. Symptoms include blurred vision, floaters, and decreased visual acuity. If left untreated, it can cause severe visual loss or sudden vision loss. Diagnosis is made based on the presence of vitreous cells and snowball or snowbank formations in the vitreous. Treatment involves systemic corticosteroids or immunosuppressive drugs to reduce inflammation. Additional treatments may include periocular corticosteroid injections, cryotherapy, or vitrectomy.

1. Bipin Bista
Resident
Ophthalmology
NMCTH

2.  Diagnosis of intermediate uveitis is made by
inflammation primarily involves vitreous &
peripheral retina.
 In 1960 Brockhurst & colleagues described it as
inflammation characterized by white
accumulation on pars plana.
 International Uveitis Study Group : intraocular
inflammation predominantly involving
vitreous & peripheral retina.

3.  National Institute of Health – 2.077 per 100000
persons.
 No gender or race predilection.
 Usually affects after the age of 40.
 HLA Association.

4.  Blurred vision
 Floaters
 Decreased visual acquity
 If inflammation persists , severe visual loss.
 Sudden loss of vision.
 Anterior segment involvement – minimal.
 AS involvement common in children.

5.  Presence of vitreous
cells (+1)
 Vitreous snowball :
white & yellow
colored aggregates .
 Coalesce to form
material : snowbank
 Periarteritis
 Perivasculitis
 Vascular cyclitic
membrane

7.  Snowbank may be discontinuous, usually
located inferiorly but can extend upto 3600
 cystoid macular oedema – FA
 Rhegmatogenous RD.
 Chronic intermediate uveitis : long standing
macular oedema – development of retinal
pigment epithelial stippling in macula.
Disc oedema, optic atrophy & optic disc
neovascularization.

8.  BENIGN
 MILD
 CHRONIC
 SEVERELY CHRONIC

9.  Sarcoidosis
 Multiple sclerosis
 IBD
 Lyme disease
 Toxocariasis
 Intraocular
Lymphoma
 Retinoblastoma
 Whipple’s Disease
 Iridocyclitis
 Multifocal choroiditis
 Irvine-Gass syndrome
 Amyloidosis
 Interstitial nephritis &
uveitis syndrome
 Cat scratch disease
 Hepatitis C
 Crohn’s Disease

11.  Optic neuritis (>50%)
 Intermediate uveitis,
anterior uveitis &
periphlebitis.
 Multiple sclerosis had
serum antibodies to
arrestin (retinal S-
antigen).

12.  Exudation
 Periphlebitis : leads to breakdown of blood-
ocular barrier.
 Snow-banking

13.  Collapsed vitreous, blood
vessels, fibroglial cells
including fibrous
astrocytes & scattered
inflammatory cells,
predominately
lymphocytes.
 Peripheral vein :
lymphocytic cuffing &
infiltration.
 Composed of epitheloid
cells & multinucleated
giant cells.
 Absent in uvea & primary
site may be vitreous.

14.  Glial tissue in the snowbank & extensive
peripheral vascular disease with perivascular
infiltration of lymphocytes & MHC II antigen.
 No substantial choroidal inflammation.

15.  Increased level of immune markers :
• Interleukin-2
• Intercellular adhesion molecule-1

16.  Exclude the possibility of underlying infectious
disease or malignancy.
 Therapy

17.  Mainstay of therapy.
 Topical not much effective.
 Systemic or periocular.
 40mg triamcinolone – 2-3 times in 8 weeks.
 Systemic – bilateral IU.
 0.5-1 mg/kg/day – Prednisolone

18.  Steroid resistant cases.
 Cyclosporin – watch for toxicity.
 Azathioprine, methotrexate, cyclophospamide,
mycophenolate mofetil.

19.  Anti – TNF monoclonal antibodies :
Daclizumab.

20.  Cryotherapy
 Vitrectomy

21.  Destroys the vascular component of peripheral
retinitis or vitreitis & eliminates the entrance
site for inflammatory mediators into the eye.
 Combined with periocular steroid injections.
 Evident within several weeks & lasts for 3-6
months.
 Complication : transient increased vitreal
inflammation, reduced accomodation, cataract
& hyphaema.

22.  Chronic inflammation
 2/3rd improvement.

23. Reference:
- Nussenblatt and whitecup 4th edition
- Myron yanoff 4th edition