Bonfioli Adriana A, Damico Francisco Max, Curi Andre L L, Orefice Fernando
Eye & Ear Institute of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Semin Ophthalmol. 2005 Jul-Sep;20(3):147-54. doi: 10.1080/08820530500232035.
Intermediate uveitis is an intraocular inflammation involving the anterior vitreous, peripheral retina and pars plana. It usually affects patients from 5 to 30 years old, without gender or racial preferences. The etiology is unknown but there are several associated diseases: multiple sclerosis, idiopathic optic neuritis, autoimmune corneal endotheliopathy, sarcoidosis, thyroid diseases and inflammatory bowel diseases. Symptoms are blurry vision, floaters and distortion of central vision. The syndrome is bilateral in 80% of the patients and chronic with periods of exacerbation and remission. Clinical presentation includes: mild to moderate anterior chamber inflammation, thin keratic precipitates in the inferior portion of the cornea, autoimmune endotheliopathy, vitreitis, vasculitis in the peripheral retina, intravitreal "snowballs," retinal "snowbanking," optic neuritis and cystoid macular edema. Cataract and glaucoma are frequent complications. Treatment of intermediate uveitis is based on periocular and oral corticosteroids. Cryotherapy or laser photocoagulation of the peripheral retina are options in patients with snowbanking when there is an insufficient response to periocular or systemic corticosteroids. Imunosuppression may also be used when other therapies fail, and Cyclosporin A is the first drug of choice. Pars plana vitrectomy is indicated in patients with chronic significant inflammation, non-responsive cystoid macular edema, non-clearing vitreous hemorrhage, tractional retinal detachment and epiretinal membranes. The long-term prognosis of intermediate uveitis is usually good, particularly with strict control of inflammation and with proper management of complications. Patients can often maintain a vision of 20/50 or better.
中间葡萄膜炎是一种累及前部玻璃体、周边视网膜和平坦部的眼内炎症。它通常影响5至30岁的患者，无性别或种族倾向。病因不明，但有几种相关疾病：多发性硬化症、特发性视神经炎、自身免疫性角膜内皮病变、结节病、甲状腺疾病和炎症性肠病。症状包括视力模糊、飞蚊症和中心视力扭曲。该综合征在80%的患者中为双侧性，呈慢性，有加重和缓解期。临床表现包括：轻度至中度前房炎症、角膜下部的薄角膜后沉着物、自身免疫性内皮病变、玻璃体炎、周边视网膜血管炎、玻璃体内“雪球”、视网膜“雪堤”、视神经炎和黄斑囊样水肿。白内障和青光眼是常见的并发症。中间葡萄膜炎的治疗基于眼周和口服皮质类固醇。当对眼周或全身皮质类固醇反应不足时，对于有雪堤的患者，周边视网膜冷冻疗法或激光光凝是选择之一。当其他疗法失败时也可使用免疫抑制，环孢素A是首选药物。对于有慢性严重炎症、无反应性黄斑囊样水肿、不吸收的玻璃体积血、牵拉性视网膜脱离和视网膜前膜的患者，可行玻璃体切除术。中间葡萄膜炎的长期预后通常良好，尤其是严格控制炎症并妥善处理并发症时。患者通常可维持20/50或更好的视力。
