Intermediate uveitis is a type of intraocular inflammation that primarily involves the vitreous and commonly the peripheral retina. It has a prevalence of 4.0-3.3 per 100,000 persons. Presentation includes blurry vision, floaters, pain, and redness. Treatment involves topical corticosteroids for unilateral disease and systemic corticosteroids like prednisone for bilateral disease. For cases with minimal response, immunosuppressants like methotrexate and mycophenolate may be used. Vitrectomy may be considered for diagnostic purposes or for cases with no response to medical therapy. With treatment, visual outcomes are often favorable though complications can include cataracts, glau

1. TITLE
• Intrermediate Uveitis
• Dr. Md. Mominul Islam
• Fellow (Vitreo-Retina)
• Ispahani Islamia Eye Institute And Hospital
Dhaka
• Bangladesh

2. INTRODUCTION
• According to Standardized Uveitis
Nomenclature Working Group
“Intraocular inflammation in which the primary
site is the vitreous but commonly involves the
peripheral retina as well”

3. EPIDEMIOLOGY AND DEMOGRAPHY
Prevalence
 4.0 per 100 000 persons
 3.3 per 100 000 persons
Incidence
 1.5 per 100 000 person-years
 2.08 per 100 000 persons.
At any age (average 31 years , more in younger)
No gender and racial predilection
Thorne and colleagues- more common in women (66.4%)
Dev Ophthalmol 2010; 47:136-147

4. PRESENTATION & CLINICAL FINDINGS
• Typically bilateral
(74.5–80% bilateral)
• Asymmetric unilaterally
• Blurry vision and
floaters
• Pain
• Redness
• photophobia
Anterior vitreous cells
Diffuse vitreous haze
Snowballs
Snowbanks
Peripheral vasculitis
manifested by
perivascular sheathing

5. Differential diagnosis of intermediate
uveitis
Infectious
• Lyme disease
• Syphilis
• Toxocariasis
• Toxoplasmosis
• Tuberculosis
Immune
• Idiopathic (nearly 70%)
• Pars planitis (36%)
• Sarcoidosis (22.2%)
• Multiple sclerosis (8%)

6. Masquerade
• Lymphoma (usually B-cell, NHL)
• Leukemia
• Amyloidosis
• Neoplasms
• Irvine–Gass syndrome

7. Treatment
Unilateral disease
Active/CME
Inactive/minimally
with smolding CME
Topcal corticosteroid
and NSAIDs
Good
respons
Posterior subtenon
kenalog

8. after 3-4 weeks
Good response
Frequent 3 per year
PSTK
Minimum response
PSTK 1st
Good response
Repeat
PSTK/IVTA
When active
Flucinolone acetonide Implant
Dexamethason intravitreal insert
No/Minimum
PSTK/IVTA 2nd
Snowbank + Snowbank -
Cryotherapy Vitrectomy
If recurrence
Systemic corticosteroid

11. Bilateral diseases
Prednisone 1 mg/kg/day
Good
response
After 2 weeks at maximum dose,
Taper by 10mg/week until 20mg
Then 15 mg
Thentaper by 2.5 mg increments
Minimum effective
dose < 5 mg daily
Prednisone
Minimum effective
dose < 5 mg daily
Prednisone

12. Prednisone 1 mg/kg/day
Minimum/No
response
Good
response
Mithotraxate 15-25 mg weekly +Folic
acid 1 mg daily
Minimum effective dose < 5 mg
daily Prednisone
Minimum/No
response
Azathioprine 50-250 mg PO Daily
Mycophenolate mofetil 500-
1500mg PO BID
Cytotoxic
agent or T cell
inhbitor
Biologic (TNF –
alpha or IL-2)
Minimum
/No
response
Consider
vitrectomy

13. Ophthalmology. 1999 Jan;106(1):111-8.
Methotrexate treatment for sarcoidosis
associated panuveitis.
Dev S, McCallum RM, Jaffe GJ.
Source: Department of Ophthalmology, Duke University Medical Center,
Durham, North Carolina, USA.
CONCLUSION:
Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-
associated panuveitis

14. Comparison of antimetabolite drugs as corticosteroid-
sparing therapy for noninfectious ocular inflammation.
Galor A, Jabs DA, Leder HA, Kedhar SR, Dunn JP, Peters GB 3rd, Thorne JE.
Source
Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Conclusions
These data suggest that the time to control of ocular inflammation is faster
with mycophenolate than with methotrexate. Azathioprine therapy has a
higher rate of treatment-related side effects compared with the other 2
agents.

15. VITRECTOMY
• Therapeutic :
a. No responsive to standard medical therapy
• Diagnostic:
a. Specimen sent for cytopathological evaluation
and/or flow cytometry
 Herpetic viral infection
 Toxoplasma
 Intraocular lymphoma

17. CLINICAL COURSE
Patients with Intermediate Uveitis
Visual outcomes often – Favorable
Mean visual acuity after 10 years of follow up-20/30
 75% maintained V/A or – 20/40 or better
One third maintained V/A – Normal without treatment

18. COMPLCATIONS
• Vision loss due to
 CME – 41.2% over 15 years & 45.7%
 Uveitic Glaucoma
 Retinal detachment
 Vitreous haemorrhage
 Cataracts – 34.2%
 Epiretinal membrane 44.4%
 Band Keratopathy