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Speaker offers lessons for managing posterior uveitis
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KAANAPALI, Hawaii — Following up on a discussion from last year's meeting, one presenter revised his words of wisdom for the management of posterior uveitis.
"Pattern recognition is everything," Daniel F. Martin, MD, told colleagues at Retina 2011. "When you factor in age of presentation, laterality of disease, and location and pattern of disease, you can figure out ... probably 70% or 80% of cases."
Dr. Martin said that testing for infectious causes of uveitis may be helpful, but testing for noninfectious uveitis is often fruitless due to the idiopathic nature of the disease.
"It is OK not to have a specific diagnosis, because the reality is that seldom does the diagnosis change how you manage those patients," Dr. Martin said.
He said that assessing angiotensin-converting enzyme levels may be helpful for diagnosing sarcoidosis but that, overall, use of noninfectious uveitis tests should be based on clinical review systems.
"HLA-B27 might be the single most important test that you order in a young, healthy patient with severe unilateral uveitis," he said.
According to Dr. Martin, toxoplasmosis may appear much different in an immunocompromised host and, in general, the diagnosis of systemic autoimmune disease rarely has any impact on treatment, except in the case of multiple sclerosis and HLA-B27.
For fluocinolone acetonide intravitreal implants (Bausch + Lomb), he recommended a large enough wound to avoid contact between the wound's anterior lip and the drug disc.
In rare cases, he also uses intravitreal methotrexate as an indirect diagnostic tool.
Dr. Martin said that ophthalmologists need to communicate regularly with patients' other physicians and reassess when a treatment is not working.
"Do not be afraid to stop, think and change courses," he said.
- Disclosure: Dr. Martin has no relevant financial interests to disclose.
Hawaiian Eye and Retina 2012 will be held January 15-20 at the Grand Wailea Resort & Spa in Maui. Learn more at OSNHawaiianEye.com or RetinaMeeting.com.