Intermediate Uveitis Components: A Hospital Based Study

Abstract

Background: Intermediate uveitis is an idiopathic, insidious, inflammatory disease affecting the pars plana, peripheral retina and underlying choroid. It accounts for 8% of all cases of uveitis and affects primarily healthy children and young adults. This research aims to study the components of intermediate uveitis at Nepal Eye Hospital in the year 2003 August to 2004 March. Methods: It was a prospective study done at Nepal Eye Hospital in the year 2003 July to 2004 March. Target population was the patients with intermediate uveitis visiting Nepal Eye Hospital in the study duration. Convenient sampling was done. Sample size was 50. Specially designed Performa of intermediate uveitis was used to collect particulars of the patients, history, clinical examination findings, investigation reports, management protocols used and the final visual outcome. Results: Intermediate uveitis was seen more in 20 to 29 years age group (38%, n=19) and least common before 10 years and after 50 years. The disease was found to be slightly more prevalent among males (52%). Among the study population, farmers constituted maximum proportion (36%, n=18) and Mongoloid origins were mostly affected (30%, n=15). Ninety percent of the patients reported blurring of vision and 72% patients reported floaters. Pain was not a frequent complaint. Only 12% of patients complained of pain. Similarly, only 10% of patients had photophobia. Forty-two had bilateral involvement of the eye while 58% had unilateral involvement. Anterior segment affection with keratic precipitates and anterior chamber cells were noted in 72% of involved eyes. All patients had normal intra ocular pressure. Vitreous cells were noted in all the affected eyes while 4% (in each eye) had vitreous snow banking and 3% (in each eye) had vitreous snowballs. Laboratory test showed normal total and differential leukocyte counts. 30% cases were mantoux positive and 10% had abnormal chest X-ray findings. Stool for ova/cyst was positive in 28% of cases. 8% of cases had associated pulmonary tuberculosis. Most of the patients (52%) received both topical steroid and posterior subtenon injection of Triamcinolone. Systemic steroid was used in 4%. No patients required antimetabolites/immunosuppressants or laser photocoagulation while 2% received cryotherapy. Cystoids macular edema was noted in one patient on presentation and complicated cataract was noted in one patient on presentation. Similarly, three patients had mild vitreous hemorrhage which resolved spontaneously. Visual acuity was improved in 52% of cases and remained static in 46% while deteriorated in 2%. Conclusions: Significantly high number of patients with intermediate uveitis has been reported from central development region, mainly from Dhading, Kathmandu and Nuwakot districts. People in their third decade were found to be commonly affected in this study. Most of the presenting cases were of Mongoloid origin. The severity of the disease was found to be in milder form with fewer complications in our study. With the treatment protocol followed, visual acuity improved in 52% of the cases. Keywords: association; intermediate uveitis; management; prevalence.