Dr. Eduardo Uchiyama, MD Management of Uveitis - Episode 3

Patient case #2: 55-year-old patient with recurrent uveitis

Eduardo Uchiyama MD reviews the case of a 55-year-old male with non-infectious uveitis.

Eduardo Uchiyama, MD: The next case is of a 55-year-old Hispanic man who presented with a 3-year history of intermediate uveitis, affecting the left eye more than the right eye, and mild macular edema in the left eye.

The patient was initially treated with systemic and topical steroids, and also a few periocular injections of triamcinolone in the left eye for recurrent inflammation. Because of the use of steroids, he later developed a cataract in that left eye and underwent uncomplicated cataract surgery. The patient had an excellent response to periocular steroids, but the effect lasted about 3 months and after that, the inflammation came back.

The patient was referred to us with active inflammation in the left eye about 2 months after receiving the last triamcinolone injection. The patient wanted to know what other options were available.

His past medical history was positive only for hypertension and he worked as a correctional officer. He's married and has 2 kids. In terms of medications, he takes lisinopril. On examination, his vision was 20/25 in the right eye and 24 in the left eye. His IOP [intraocular pressure] was normal in both eyes. His anterior chamber was clear. His lens in the right eye was clear and in the left eye he had a centered PCIOL [posterior chamber intraocular lens]. In the vitreous, he had 1+ cell but no vitreous haze in the right eye, and in the left eye, he had 2+ cells and 2+ haze.

On examination, in the right eye, we don't see much inflammation. In the left eye we see that the patient had some vitreous haze and there are some snowballs inferiorly.

Fundus autofluorescence was basically normal in both eyes. In the early phases of the fluorescein angiogram, in the right eye, we see minimal patchy perivascular exudation superiorly.

If we will wait a little bit longer, we see how the right eye inflammation is still mild but present. In the left eye, we see that there is more severe perivascular exudation throughout the fundus.

Transcript Edited for Clarity