Consider possibility of infection, syphilis when managing uveitis
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SEATTLE — Chronic and recurrent uveitis requires chronic treatment, according to a speaker here.
While repeated steroid injections may be useful for acute or infrequent uveitis, they are suboptimal for chronic uveitis, Nisha Acharya, MD, MS, said at the American Society of Retina Specialists annual meeting. Long-term options include sustained-release corticosteroids and systemic immunomodulatory therapy.
Acharya shared pearls for uveitis management, noting that uveitic macular edema often requires ongoing treatment.
“Uveitic macular edema is a major problem in uveitis. Forty percent of patients who have intermediate posterior panuveitis will have macular edema,” Acharya said. “It is the No. 1 cause of vision loss in patients with uveitis. Macular edema is really hard to treat. It often requires ongoing therapy.”
It is important to consider the possibility of syphilis in patients with uveitis, she said.
“It is standard of care to check for syphilis in a patient with uveitis no matter what treatment you are doing, especially if you are going to do steroid injections,” Acharya said.
Retina specialists should also consider the possibility of infection if a patient has an atypical clinical response to treatment, Acharya said. Vitreoretinal lymphoma remains a challenge to diagnose, and multimodal imaging is necessary to assess the level of inflammation.
A diagnosis of ocular lymphoma can be elusive, and failure to respond to immunosuppressive treatment may be a clue for the presence of the condition. Metagenomic sequencing, Acharya said, can help identify pathogens and cancer mutations concurrently.
“Sometimes it requires repeated vitrectomies and samplings,” she said. “It can be very tricky, and sometimes labs have a hard time processing it or it can degrade in the time it goes to the lab, so it may take a long time to diagnose.”
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Acharya N. Uveitis pearls for the retina specialist. Presented at: American Society of Retina Specialists annual meeting; July 28-Aug. 1, 2023; Seattle.
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