Edema of the vitreous
Peripheral uveitis - idiopathic, long-lastinginflammatory process with lesion of the flat part of the ciliary body, the peripheral part of the retina and the underlying choroid. It accounts for about 8% of all uveitis. Despite the fact that the process is often two-sided, it proceeds asymmetrically. In 10-15% of patients later developed multiple sclerosis, observed with histocompatibility with HLA-DR15.
1. It appears in 2-4 decades of life the appearance of floating opacities or a decrease in the severity of central vision due to the development of edema of the macula.
2. Symptoms of peripheral uveitis
a) Vitreit with a low degree of activity of inflammation in the anterior chamber. The severity of vitreit may be different
• Cell suspension in the anterior part of the vitreous.
• Exudate in the form of "snow flakes" or cotton-like foci.
• Diffuse condensation of the vitreous body in the form of a "leaf of a tree".
• Total opacity of the vitreous humor;
b) peripheral periphlebitis retina occurs frequently;
at) exudate in the form of "snow flakes" - the main featureinflammation of the flat part of the ciliary body. Exudate gray or white in the lower part of the ciliary body is determined when examining the periphery of the fundus by a three-mirror Goldmann lens with a scleral depression. The exudate can spread posteriorly, thereby covering the peripheral parts of the retina.
3. Flow. The inflammatory process often lasts for several yearswith a lot of exacerbations and incomplete remissions, can sometimes occur with single, treatment-free exacerbations. But despite this, the vision forecast remains good.
Complications of peripheral uveitis
1. Cystic edema of the macula is the cause of reduced visual acuity.
2. Macular epiretinal gliosis develops often.
3. Secondary cataract develops with a severe and prolonged course of the inflammatory process.
4. Traction retinal detachment is the result of densification of the fibrovascular tissue in the flat part of the ciliary body (also appears in vitreal hemorrhages).
5. Formation of an inflammatory membrane observed with massive proliferationvascularized exudate around the posterior capsule of the lens. When the membrane is stretched, the detachment of the ciliary body develops with a decrease in fluid secretion and the development of hypotension, and then the phthisis of the eyeball.
Treatment of peripheral uveitis is several years. The main indication for the therapy is a visual acuity of 0.5 (6/12) or less due to the development of persistent cystic edema of the macula.
1. The posterior subtenone injection of triamcinolone acetonide (kenalog) or methylprednisolone acetate (depomedron) is effective in most cases. The frequency of repeated injections is determined by visual acuity, and not by the severity of vitreitis.
2. Systemic steroids or immunosuppressive drugs are used when parabulbar injections are ineffective.
3. Cryotherapy of the base of the vitreous body is carried out after arresting the inflammatory process.
4. Vitrectomy through the flat part of the ciliary body is carried out with the development of hemorrhages and total opacity of the vitreous, epiretinal membranes and traction of retinal detachment.
Diseases that occur with the development of inflammation in the vitreous, in the absence of significant changes in the retina:
1. Uveitis with Fuchs syndrome
• Similarities: affects young people, "floating points" and anterior uveitis of mild severity.
• Differences: predominantly one-sided, there is a slight atrophy of the iris.
2. Systemic diseases. at which secondary peripheral uveitis develops: sarcoidosis, Lyme disease, non-Hodgkin's B-cell lymphoma, cat scratch disease and Vipple's disease.