Uveitis Update DISCLOSURE STATEMENT. Featured Speaker: Dr. Kyle Cheatham, FAAO, DIP ABO
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1 Uveitis Update Featured Speaker: Dr. Kyle Cheatham, FAAO, DIP ABO DISCLOSURE STATEMENT We have no direct financial or proprietary interest in any companies, products or services mentioned in this presentation.
2
3 45 year old / AA female / Photophobic Red Free Analysis
4 Q A What is the MOST Sarcoidosis likely cause of this uveitis? Tuberculosis Rheumatoid arthritis Ankylosing spondylitis
5 Q A What is the MOST Sarcoidosis likely cause of this uveitis? Tuberculosis Rheumatoid arthritis Ankylosing spondylitis
6 Q A What is the MOST Rheumatoid arthritis common systemic etiology for acute Inflammatory bowel disease anterior uveitis? Osteoarthritis Ankylosing spondylitis
7 Q A What is the MOST Rheumatoid arthritis common systemic etiology for acute Inflammatory bowel disease anterior uveitis? Osteoarthritis Ankylosing spondylitis
8 UVEITIS ANTERIOR NON-GRANULOMATOUS (95%) CHRONIC GRANULOMATOUS (5%) IDIOPATHIC - 50% OF CASES TUBERCULOSIS OTHER 50% = 3 MAIN CONDITIONS! SARCOID
9 ANTERIOR NON-GRANULOMATOUS UVEITIS ANKYLOSING SPONDYLITIS REACTIVE ARTHRITIS INFLAMMATORY BOWEL DISEASE LOWER BACK PAIN URINATION ISSUES DEFECATION ISSUES
10 NON-GRANULOMATOUS UVEITIS 50% IDIOPATHIC 50% UCRAP 80% (ANKYLOSING SPONDYLITIS)
11 Approximately 50% of cases of acute, non-granulomatous, anterior uveitis are idiopathic. Approximately 50% of cases of new onset anterior uveitis have associated spondyloarthropathy; 80% of these patients have ankylosing spondylitis. - Page 92
12 How do I decide when to work-up a uveitis patient? Most common causes include U-CRAP: Ulcerative colitis Crohn s disease Reactive arthritis Ankylosing spondylitis Psoriatic arthritis. - Page 92
13 Peripheral Anterior Synechiae THREAT No.1
14 Posterior Synechiae THREAT No.2 Fibrin in posterior chamber Posterior synechiae
15 Q A What is the best topical agent to break posterior synechiae? Phenylephrine 10% Tropicamide 1% Tropicamide.5% Phenylephrine 2.5%
16 Q A What is the best topical agent(s) to break posterior synechiae? Phenylephrine 10% Tropicamide 1% Tropicamide.5% Phenylephrine 2.5%
17 Q A Which of the following statements is FALSE regarding posterior synechiae? Can occur when the iris is in the miotic or dilated position. Become permanent if they are not broken during the initial episode of inflammation. Leads to iris bombe, angle closure, and an acute elevation in IOP if occurs 360 degrees. Rarely develops in the early stages of acute uveitis.
18 Q A Which of the following statements is FALSE regarding posterior synechiae? Can occur when the iris is in the miotic or dilated position. Become permanent if they are not broken during the initial episode of inflammation. Leads to iris bombe, angle closure, and an acute elevation in IOP if occurs 360 degrees. Rarely develops in the early stages of acute uveitis.
19 Cystoid Macular Edema THREAT No.3
20 Q A Which of the following is FALSE regarding the utilization of cycloplegics for acute anterior uveitis? Cycloplegics stabilize the blood aqueous barrier by constricting the iris and ciliary body vasculature. Cycloplegics reduce pain by paralyzing the ciliary and sphincter muscles. Cycloplegics dilate the pupil and reduce the risk of posterior synechiae formation. Cycloplegics act on the trabecular meshwork to increase aqueous outflow.
21 Q A Which of the following is FALSE regarding the utilization of cycloplegics for acute anterior uveitis? Cycloplegics stabilize the blood aqueous barrier by constricting the iris and ciliary body vasculature. Cycloplegics reduce pain by paralyzing the ciliary and sphincter muscles. Cycloplegics dilate the pupil and reduce the risk of posterior synechiae formation. Cycloplegics act on the trabecular meshwork to increase aqueous outflow.
22 Steroid Response Facts: Pred Forte and Durezol both cause elevated IOP in approximately 5-10% of patients. - Page 97
23 Steroid Response Facts: Pred Forte and Durezol both cause elevated IOP in approximately 5-10% of patients. There is evidence from small clinical trials that Durezol results in a significantly greater IOP increase (average 20 mmhg) compared to Pred Forte (average 10 mmhg), especially in children. - Page 97
24 Dose Durezol Q 3-4hrs or half as frequently as Pred Forte Q1-2hrs. - Page 197
25 Dose Durezol Q 3-4hrs or half as frequently as Pred Forte Q1-2hrs. Dose homatropine 5% Q12hrs; use at least one daily until the anterior chamber is completely free of cells. - Page 197
26 Dose Durezol Q 3-4hrs or half as frequently as Pred Forte Q1-2hrs. Dose homatropine 5% Q12hrs; use at least one daily until the anterior chamber is completely free of cells. Break posterior synechiae during the current episode to prevent permanent PS. - Page 197
27 Uveitis Pearls Three main threats to vision (PAS, PS, CME) Anterior non-granulomatous Big-3 Dosing reminders (always Pred Forte, Durezol ) Subclinical uveitis
28 kmkupdate.com
29 Uveitis Update Featured Speaker: Dr. Kyle Cheatham, FAAO, DIP ABO DISCLOSURE STATEMENT We have no direct financial or proprietary interest in any companies, products or services mentioned in this presentation.
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