Definition: Bilateral granulomatous panuveitis that occurs after surgery or penetrating injury to the other eye.
90% develop within 1 year.
Incidence of 0.2% after trauma & 0.01% after surgery.
Early treatment – 50% achieved 6/12 VA.
Late complications – secondary glaucoma, chronic maculopathy, phthisis bulbi.
- Bilateral AAU with mutton fat KPs (classical)
- Dalen-Fuchs nodules – white-yellowish lesions at RPE
- Exudative RD / ONH oedema / CNV / vasculitis / choroiditis / vitritis / CMO
- Good history and clinical examination.
- Investigative tools – FFA, ICG, OCT, USS
- High dose steroids (up to 2mg/kg/day) with gradual tailoring up to 3 months or pulse methylprednisolone (1g/day) for 3 days.
- Immunosuppressive therapy – cyclosporine, cyclophosphamide, azathioprine, chlorambucil.
- Intravitreal therapy – IVTA
- Prophylactic evisceration/enucleation of injured eye within 10 days.
Special note: With current surgical trend (especially VR surgery), any clinical uveitis in fellow eye – to consider this disease.
- Vogt-Koyanagi-Harada disease – usually Asian/blacks, no penetrating injury, with common skin and CNS changes and exudative RD and pleoyctosis in CSF.