Intermedial uveitis: clinical course in ten years follow up

Purpose: Intermedial uveitis (IU) is a chronic ocular disorder of unknown origin with frequent development of macular edema. The long term course of IU is not yet known and is a subject of this study Methods: Retrospective study of 28 patients with IU (12 males, 16 females; 49 affected eyes) in whom a follow up of at least 10 years starting with the onset of IU was available. Results: The average age at the onset of IU was 37. Five patients had an associated systemic disease (2 sarcoidosis and 3 multiple sclerosis). At onset bilateral involvement was observed in 20/28 (71%) patients. Visual acuity (VA) of more than 0.8 was noted in 19/48 (39%) affected eyes; and VA of less than 0.1 in 2/48 (4%) affected eyes. Systemic treatment with immunosuppressant drugs was required in 7/28 cases (25%) and 13 eyes underwent one or more surgical procedures (cataract surgery in 10 eyes, pars plana vitrectomy in 2 eyes, scleral buckling in 1 eye). At ten-year follow-up VA of more than 0.8 was noted in 22/49 (45%) affected eyes; and VA of less than 0.1 in 10/49 (8%) affected eyes. The causes of visual loss included predominantly cataract, macular edema and vitreous opacities. Moreover, during the ten-year follow up intraocular inflammation diminished in 10/28 (36%) patients. The mean time to remission was 5.4 years (range 2-12 years). During the follow up, systemic disease sarcoidosis and multiple sclerosis manifested in two additional patients. Conclusions: The main complication of IU consisted of cataract, followed by macular edema and vitreous opacities. Within ten-year of follow-up one third of patient with IU achieved the long-term remission of the intraocular inflammation.