1 / 16

Uveitis

Uveal Tract . Arthritis

Albert_Lan
Download Presentation

Uveitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Uveitis Aileen Dillon, M.D. TPMG, Rheumatology San Francisco

    2. Uveal Tract

    3. Uveitis Classification AU - Anterior Uveitis Involves Iris &/or Pars Plicata Includes Iritis, Ant Cyclitis, Iridocyclitis IU - Intermediate Uveitis Involves Pars Plana &/or adjacent Retina Includes Pars Planitis, Post Cyclitis, Hyalitis, Basal Chorioretinitis PU - Posterior Uveitis Involves Choroid &/or Retina Includes Focal, Multifocal, Diffuse Choroiditis, Chorioretinitis, Retinochoroiditis, Neuroretinitis Panuveitis involves - 2 of 3 above

    4. Uveitis General Facts Occurs worldwide Incidence: 17 - 22.6 per 100,000/year Prevalence: 38 -370 per 100,000 Accounts for 10-15% severe visual loss in US Mean age at presentation = 40 yrs (IU -30 yrs) Peak age of onset = 3rd & 4th decades Systemic disease present in 50% (tertiary referral center)

    5. Uveitis General Facts Chronic uveitis more common than acute or recurrent Chronic uveitis most common form with IU Non-granulomatous > granulomatous especially in AU Non-infectious > infectious especially in PanU and AU Bilateral > unilateral in PanU and IU Bilateral = unilateral in AU and PU

    6. Uveitis Distribution & Etiology Differs based on geography, genetics, environmental factors Differs between community and tertiary referral practices MEEI (tertiary referral 1237 patients) 1997 AU = 52%, IU = 13%, PU = 19%, PanU = 16% LA (community (C) and tertiary (T) 426 patients) 1996 C: AU = 91%, IU = 1%, PU = 5%, PanU = 1% T: AU = 61%, IU = 12%, PU = 15%, PanU = 9%

    7. Causes of Anterior Uveitis (MEEI) Idiopathic 37.8% HLA-B27 assoc arthropathies 21.6% JRA 10.8% Herpetic Uveitis 9.7% Sarcoidosis 5.9% Fuchs' heterochromic iridocyclitis 5% SLE 3.3% Others: lens induced (1.2%), Posner-Schlossman syndrome (0.9%), RA (0.9%), Syphilis, TB, phacogenic uveitis, Lyme disease, Wegeners, PAN, Relapsing Polychondritis

    8. Causes of Intermediate Uveitis (MEEI) Idiopathic 69.1% Sarcoidosis 22.2% Multiple Sclerosis 8% Lyme disease 0.6%

    9. Causes of Posterior Uveitis (MEEI) Toxoplasmosis 24.6% CMV retinitis 11.6% SLE 7.9% Birdshot retinochoroidopathy 7.9% Sarcoidosis 7.5% Acute retinal necrosis syndrome 5.5% EBV retinochoroiditis 2.9% Bechet's disease 2% Others: Syphilis (2%), Toxocariasis, MS, Temporal Arteritis, POHS

    10. Causes of Panuveitis (MEEI) Idiopathic 22.2% Sarcoidosis 14.1% Multifocal choroiditis and panuveitis 12.1% Bechet's disease 11.6% SLE 9.1% Syphilis 5.5% Vogt-Koyanagi-Harada syndrome 5.5% HLA-B27 associated 4.5% Others: Sympathetic Ophthalmia (4%), TB (2%), fungal retinitis (2%), bacterial panophthalmitis, lymphoma, RP, PAN, leprosy, DM, PSS

    11. Uveitis Pathogenesis Immune privilege and the eye Th1 cell mediated immune disease APCs: retinal endothelial, Muller, ciliary epithelial, retinal pigment epithelial cells Genetic associations: acute anterior uveitis - HLA-B27 JRA iridocyclitis - HLA-DR5 Bechet's disease - HLA-B51 Birdshot chorioretinitis - HLA-A29 VKH - HLA-DR4 Pars Planitis & MS - HLA-DR15

    12. Uveitis Animal Models (1 of 2)

    13. Uveitis Animal Models (2 of 2)

    14. Uveitis Diagnostic Approach Combined Ophthalmologic and Rheumatologic approach Ophthalmologic patterns based on anatomic location, laterality, course, predominant morphology of posterior pole involvement Appropriate physical examination Selected tests: Xrays: CXR (Sarcoidosis, TB), SI joints Serologies: Toxo, Lyme, ANA, RPR, HLA GI evaluation (IBD) Lumbar Puncture (VKH) Aqueous Humor analysis

    15. Uveitis Complications Glaucoma Cataracts Cystoid macular edema (major cause of blindness) Macular scar Retinal detachment Vitreous hemorrhage Band keratopathy (JRA)

    16. Uveitis Aileen Dillon, M.D. TPMG, Rheumatology San Francisco

More Related