Posterior Uveitis

Posterior Uveitis

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Posterior Uveitis is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • Choroiditis

Disorder Subdivisions

  • None

General Discussion

Uveitis is a general term that refers to inflammation of the part of the eye known as the uvea.

The uvea is a relatively thick, strong layer of fibrous tissue that encloses and protects the eyeball. It consists of three parts: the iris, the ciliary body, and the choroid.



There are three types of uveitis, classified according to the part of the uvea that is affected. Anterior uveitis, which affects the front part of the eye, is also sometimes called iritis since the iris is part of the front of the eye. Intermediate uveitis, also known as pars planitis or cyclitis, refers to inflammation of tissues in the area just behind the iris and lens of the eye. Posterior uveitis, also known as choroiditis, refers to inflammation of the choroid, the back part of the uvea. Posterior uveitis may affect the retina and/or the optic nerve, and may lead to permanent loss of vision.



Posterior uveitis is the rare form of the disorder and is the type of uveitis most associated with loss of vision. The other two forms are more common, and more frequently result in acute symptoms, but only rarely cause vision loss.

Symptoms

Posterior uveitis is usually, but not always, painless. Symptoms typically include "floaters", small specks, flakes, or clouds that move through the field of vision, and decreased vision. While anterior uveitis often causes eye pain and redness, light sensitivity, and blurred vision, the symptoms of posterior uveitis are more subtle.



Uveitis can lead to other complications, including glaucoma, cataracts, or retinal detachment. Early detection and treatment is important to reduce the risk of permanent vision loss.

Causes

Posterior uveitis can have infectious or noninfectious causes. Infectious causes include bacterial, fungal, parasitic, and viral infections. Noninfectious causes include immunologic problems, allergies, malignancies, and unknown causes.



One report suggests that about 60% of cases are caused by problems intrinsic to the eye itself and that the other 40% of cases are the result of associated autoimmune disorders, infections, and/or trauma. Some of the disorders with which posterior uveitis is sometimes associated are Behcet's syndrome, ankylosing spondylitis, Lyme disease, sarcoidosis, and psoriasis. Among children, the disorder is frequently associated with juvenile rheumatoid arthritis.

Affected Populations

Posterior uveitis occurs as an isolated condition or as part of other disease affecting body systems (systemic). This condition affects males and females in equal numbers. It can strike at almost any age, although it appears most often to occur between the ages of 20 and 50. According to one estimate, chronic, non-infectious posterior uveitis affects 175,000 people in the United States and 800,000 people worldwide. Almost 80% of cases of uveitis affect the front (anterior) portion of the eye.

Standard Therapies

Diagnosis

The first step in diagnosis is to determine the role, if any, of other immunological and/or infectious conditions in the development of the disorder. Blood studies for infectious agents such as herpes virus, toxoplasmosis, toxocariasis and spirochetes are helpful. Chest x-rays may detect sarcoidosis or tuberculosis. If systemic or central nervous system involvement is present or large cell lymphoma is suspected, neuroimaging studies and lumbar puncture may be used.



Treatment

It is important to identify and treat an underlying infection or immunological disorder before initiating other treatment. Steroids administered intravenously are often used as a treatment for posterior uveitis. However, long-term use of systemic corticosteroids carries with it the risk of increased pressure in the eye (glaucoma) and cataracts, so the patient must be followed closely.



In April of 2005, the FDA announced the approval of the orphan product Retisert (an implant) for the treatment of chronic, non-infectious posterior uveitis. The implant, a tiny drug reservoir, delivers approximately two-and-a-half years of the anti-inflammatory corticosteroid, fluocinolone acetonide, directly to the back of the eye. For information, contact the manufacturer:



Bausch & Lomb

One Bausch & Lomb Place

Rochester, NY 14604-2701

Telephone: (585) 338-6000

www.bausch.com

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com



Currently, the National Eye Institute is sponsoring clinical trials involving posterior uveitis. Two of these studies involve the use of a monoclonal antibody as a treatment for posterior uveitis. Monoclonal antibodies are genetically engineered proteins designed to affect a specific target or biochemical reaction within the body. In these trials, the monoclonal antibody is known as daclizumab and it inhibits a specific chemical reaction needed by lymphocytes to produce inflammation. For information about these and other current trials, visit the ClinicalTrails.gov web site or contact the NIH Patient Recruitment Office (see above).

References

TEXTBOOKS

Wade NK, Seto RJ. Posterior Uveitis. In: The NORD Guide to Rare Disorders, Philadelphia: Lippincott, Williams and Wilkins, 2003:666.



Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:725-29.



Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1305-06.



Kanski JJ., ed. Clinical Ophthalmology. 4th ed. Butterworth-Heinemann. Oxford, UK; 1999:264-319.



REVIEW ARTICLES

Ciulla TA, Walker JD, Fong DS, et al. Corticosteroids in posterior segment disease: an update on new delivery systems and new indications. Curr Opin Ophthalmol. 2004;15:211-20.



Ciardella AP, Borodoker N, Costa DL, et al. Imaging the posterior segment in uveitis. Ophthamol Clin North Am. 2002;15:281-96.



Okada AA. Drug therapy in Behcet's disease. Ocul Immunol Inflamm. 2000;8:85-91.



JOURNAL ARTICLES

Menezo V, Lau C, Comer M, et al. Clinical outcome of chronic immunosuppression in patients with non-infectious uveitis. Clin Experiment Ophthalmol. 2005;33:16-21.



Chen CS, Robertson D, Hammerton ME. Juvenile arthritis-associated uveitis: visual outcomes and prognosis. Can J Ophthalmol. 2004;39:614-20.



Murphy CC, Greiner K, Plskova J, et al. Neutralizing tumor necrosis factor activity leads to remission in patients with refractory non-infectious posterior uveitis. Arch Ophthalmol. 2004;122:845-51. Erratum in: Arch Ophthalmol. 2004;122:1336.



Lobo A, Barton K, Minassian D, et al. Visual loss in sarcoid-related uveitis. Clin Experiment Ophthalmol. 2003;31:310-16.



Toker E, Kazokoglu H, Acar N. High-dose intravenous therapy for severe posterior segment uveitis in Behcet's disease. Br J Ophthalmol. 2002;86:521-23.



FROM THE INTERNET

Uveitis. University of Maryland Medicine. Review Date: October 2000. 5pp.

www.umm.edu/altmed/ConsConditions/Print/Uveitiscc.html



Dick AD. Uveitis. Contact a Family. Last reviewed October 2001. 3pp.

www.cafamily.org.uk/Direct/u20.html

Resources

American Autoimmune Related Diseases Association, Inc.

22100 Gratiot Ave.

Eastpointe, MI 48021

Tel: (586)776-3900

Fax: (586)776-3903

Tel: (800)598-4668

Email: aarda@aarda.org

Internet: http://www.aarda.org/



NIH/National Eye Institute

31 Center Dr

MSC 2510

Bethesda, MD 20892-2510

United States

Tel: (301)496-5248

Fax: (301)402-1065

Email: 2020@nei.nih.gov

Internet: http://www.nei.nih.gov/



NIH/National Institute of Allergy and Infectious Diseases

Office of Communications and Government Relations

6610 Rockledge Drive, MSC 6612

Bethesda, MD 20892-6612

Tel: (301)496-5717

Fax: (301)402-3573

Tel: (866)284-4107

TDD: (800)877-8339

Email: ocpostoffice@niaid.nih.gov

Internet: http://www.niaid.nih.gov/



Ocular Immunology and Uveitis Foundation

5 Cambridge Center

8th Floor

Cambridge, MA 02142

Tel: (617)621-6377

Fax: (781)431-2042

Tel: (866)353-6377

Email: fosters@comcast.net

Internet: http://www.uveitis.org



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



AutoImmunity Community

Email: moderator@autoimmunitycommunity.org

Internet: http://www.autoimmunitycommunity.org



For a Complete Report

This is an abstract of a report from the National Organization for Rare Disorders, Inc.® (NORD). Cigna members can access the complete report by logging into myCigna.com. For non-Cigna members, a copy of the complete report can be obtained for a small fee by visiting the NORD website. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational treatments (if available), and references from medical literature. For a full-text version of this topic, see http://www.rarediseases.org/search/rdblist.html.

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