Posterior uveitis refers to a group of inflammatory diseases affecting the choroid, retina, retinal blood vessels, and vitreous. Clinically, it encompasses conditions such as choroiditis, retinitis, chorioretinitis, retinochoroiditis, and retinal vasculitis.
Clinical Manifestations
Symptoms
The symptoms depend on the type, location, and severity of the inflammation. Common symptoms include floaters or dark spots in the visual field, flashes of light, distorted vision, blurred vision, or decreased visual acuity. Patients with systemic diseases may also exhibit corresponding systemic symptoms.
Signs
The signs vary according to the site, extent, and severity of the inflammation. Frequently observed signs include:
- Inflammatory cells and opacities in the vitreous
- Focal chorioretinal infiltrative lesions, which may vary in size, potentially forming scar lesions in the later stages
- Diffuse choroiditis
- Retinal vasculitis, characterized by vascular sheathing, vascular occlusion, and hemorrhage
- Retinal edema or macular edema
Additionally, exudative retinal detachment, proliferative vitreoretinopathy, retinal neovascularization, choroidal neovascularization, and vitreous hemorrhage may also occur. Anterior segment involvement is generally absent, though mild flare in the anterior chamber and a small number of anterior chamber inflammatory cells may occasionally appear.
Diagnosis
The diagnosis can be made based on typical clinical manifestations. Fluorescein fundus angiography (FFA) is highly useful for assessing retinal and vascular inflammation as well as choroidal pigment epithelial changes. Indocyanine green angiography (ICGA) assists in identifying choroidal and vascular lesions. B-scan ultrasonography, optical coherence tomography (OCT), computed tomography (CT), and magnetic resonance imaging (MRI) may also aid in determining inflammation-induced lesions or in identifying potential causes. Additionally, laboratory tests can be selected based on the patient's clinical presentation.
Treatment
For inflammation caused by infectious factors, appropriate anti-infective therapy is necessary.
For inflammation arising from immune-mediated factors, immunosuppressive therapy is the primary treatment approach.
Unilateral cases may be managed with posterior sub-Tenon injection of corticosteroids.
Bilateral cases, or unilateral cases unsuitable for posterior sub-Tenon injection, may be treated with oral corticosteroids. Additional agents such as chlorambucil, cyclophosphamide, or cyclosporine can be considered, and anti-tumor necrosis factor (TNF) antibodies may be used in managing refractory non-infectious posterior uveitis. Since some types of posterior uveitis are particularly resistant to treatment, adequate treatment duration is essential. Combination therapy can reduce drug side effects and enhance therapeutic efficacy. Regular monitoring of liver and kidney function, blood counts, and blood glucose levels is essential during treatment to avoid severe drug-related toxicity and adverse effects.
Retinal or choroidal neovascularization may require interventions such as laser photocoagulation or anti-vascular endothelial growth factor (anti-VEGF) therapy.