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Uveal Tract Diseases

Uveal Tract Diseases. Outline Uveal tract is inclined to be affected by autoimmunity 、 infection 、 metabolism 、 hematogenous factor 、 tumor, et al. melanin correlated Ag Choroidal blood flow is slow Ag of retina and lens cause uveitis

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Uveal Tract Diseases

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  1. Uveal Tract Diseases

  2. Outline Uveal tract is inclined to be affected by autoimmunity、infection、metabolism、hematogenous factor、tumor, et al. • melanin correlated Ag • Choroidal blood flow is slow • Ag of retina and lens cause uveitis • Inflammation is the most common reason, tumor is the second.

  3. Uveitis

  4. Outline • The term “uveitis” denotes inflammation of the uvea、retina、retinal vasculature and vitreous. • Uveitis is a common cause of blindness, usually affects young people and associated with systemic autoimmune diseases.

  5. Etiology and mechanism • inflammation • Autoimmune factor • Oxidize damage • The metabolites of arachidonic acid • Immunogenetics

  6. Classification • According to causes:infective and non-infective uveitis • According to clinical pathology:granulomatous and nongranulomatous uveitis • According to anatomy:anterior、intermediate、posterior uveitis and panuveitis.

  7. Anterior uveitis Anterior uveitis consists of iritis、iridocyclitis、anterior cyclitis. classify by process: (1)acute anterior uveitis:HLA—B27 positive. (2)chronic anterior uveitis:such as Fuchs heterochromic uveitis、glaucomatocyclitic crisis, et al. (3)either acute or chronic: such astuberculosis、syphilis、chronic arthritis.

  8. Clinical findings • Symptoms: pain、photophobia、tearing、blurred vision. • Signs: (1)ciliary congestion or mixed congestion (2)KP: • corneal endothelium injury • inflammatory cells and pigments existence.

  9. Classification of KP : • Stellate KP:neutrophil、lymphocyte and plasma cells, ——nongranulomatous uveitis. • Medium sized KP:neutrophil、lymphocyte and plasma cells.——Fuchs heterochromic uveitis and uveitis secondary by herpes simplex virus keratitis. • Mutton fat KP:macrophage and epithelioid.——granulomatous uveitis.

  10. Location of KP • Arlt’s triangle:the most common,seen in many types of anterior uveitis • Pupillary cornea:seen in Fuchs heterochromic uveitis 、 uveitis due to herpes simplex virus and glaucomatocyclitic crisis. • diffuse distribution:seen in Fuchs heterochromic uveitis 、 uveitis due to herpes simplex virus .

  11. (3)Flare in the aqueous:It is because of the damage of blood-aqueous barrier and protein enter into aqueous, presents when anterior uveitis、ACG、blunt trauma. (4)Cell in the aqueous:inflammatory cells display uniform gray particles under slit lamp. Particularly severe anterior chamber inflammation may result in layering of inflammatory cells in the inferior angle(hypopyon).

  12. (5)Change in iris: may be edema、texture unclear, et al. • the synechia between iris and the anterior surface of lens is called irisposterior synechiae. • When posterior synechiae is exensive,aqueous cannot outflow,usually produce pupillary seclusion and forward bulging of the iris,is called iris bombe. • Synechia between iris and the posterior surface of cornea is called irisanterior synechiae.

  13. Iris nodules: ①Koeppe nodules: gray semitransparent nodules presenting at the iris margin——nongranulomatous uveitis ②Busacca nodules: white or gray semitransparent nodules presenting in the iris parenchyma——granulomatous uveitis ③Iris granuloma:single pink opaque nodulespresenting in the iris parenchyma——sarcoidosis

  14. (6)Change of pupil:miosis or irregular due to spasm of ciliary muscle and contraction of sphincter pupillae muscle. • The pupil may be small or irregular due to the formation of the iris posterior synechiae. If iris synechiae reach 360 degree,is called Seclusio pupillae. • If fibrous membrane cover the whole pupil,is called occlusion of pupil.

  15. (7)Change of lens: some pigment may be deposit on the surface of lens in uveitis; circular shape pigment deposition often occur after release of iris posterior synechiea. (8)Change of posterior segment:Cells in the anterior vitreous ,cystoid macular edema、optic edema.

  16. Complications • Complicated cataract:due to the change of aqueous content or application of corticosteroid. • Secondary glaucoma:inflammatory cells、fibrous exudation and tissue fragments block trabecular meshwork;the seclusion and occlusion of pupil impede aqueous outflow. • Ocular hypotension and atrophy of eyeball:ciliary body atrophy——aqueous  ——IOP

  17. Differential Diagnosis 1、Acute conjunctivitis 2、Acute angle closure glaucoma 3、intraocular tumor 4、diffuse uveitis

  18. Treatment principle • Mydri asis immediately : prevent iris posterior synechiae. • Anti-inflammation in time: prevent tissue injury and complications.

  19. 1.Cycloplegics: 1%、2%、4% Atropine ①prevent and cure iris posterior synechiae,prevent complications; ②release the spasm of ciliary muscle and Sphincter pupillae muscle,then reduce congestion、edema、inflammation and pain. 2.Corticosteroids: local and systemic application 3.NSAID

  20. 4.Treat primary diseases: 5.Treatment of complications: • Secondary glaucoma: • take diamox orally and timolol eyedrop. • If pupillary block exist, perform laser iridotomy or iridotomy in time. • If Anterior chamber angle extensively adhere,perform trabeculectomy. • Complicated cataract: when inflammation under good control,perform cataract extraction and IOL implantation.

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