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Presentation. 58/Malay/Male 1 year history of blurring of vision R > L PMH: Hypertension, Gout No ulcers/urinary symptoms. Examination. Right Left VA (aided) 6/45 6/15 IOP 15 17 Anterior chamber Trace cells 2+ cells NS 4+ NS 2+

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  1. Presentation • 58/Malay/Male • 1 year history of blurring of vision R > L • PMH: Hypertension, Gout • No ulcers/urinary symptoms

  2. Examination Right Left • VA (aided) 6/45 6/15 • IOP 15 17 • Anterior chamber Trace cells 2+ cells NS 4+ NS 2+ • Cornea Rt old interstitial keratitis Band keratopathy Rt corneal stromal vascularisation

  3. Fundal exam • Rt eye hazy view • Lt eye vitreous cells 2+, cystoid macular oedema • Diagnosis: Rt old IK with bilateral intermediate uveitis (L>R)

  4. Investigations • FBC TW 8.8 (Lymph 25.6%, PMN 62%) • ESR 91mm/hr • ANA Negative • Anti-ds DNA Negative • ANCA Negative • CXR Normal • RPR Reactive in 1:4 dilution • TPHA Reactive in >=1:1280 dilution

  5. Diagnosis • Right interstitial keratitis (old) + • Bilateral intermediate uveitis (L>R), • Complicated by left cystoid macular oedema, • Secondary to luetic disease

  6. Management • Gutt Prednisolone 1% Q3H BE • Subtenon’s triamcinolone acetonide (for CMO) • OCT 399 microns

  7. Management • Referral to DSC, Kelatan clinic • LP WBC 0 per mm3 Gluc 3.1 mmol/L Chloride 121 mmol/L T. Protein 0.5 g/L RBC Few VDRL Non-reactive FTA/ABS IgG/IgM Non-reactive

  8. Follow-up • Imp : Late latent syphilis • Mx: 3 x IM benzylpenicillin • Further plans • Monitor with serology titres • Further review: Resolution of uveitis • Listed for right cataract surgery after 3 months of quiescence.

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