|Year : 1979 | Volume
| Issue : 4 | Page : 26-27
Vijaya Hospital and Voluntary Health Services Medical Centre, Madras-20, India
S S Badrinath
Vijaya Hospital and Voluntary Health Services Medical Centre, Madras-20
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Badrinath S S. Pars planitis. Indian J Ophthalmol 1979;27:26-7
Pars planitis is a form of peripheral uveitis wherein the clinical features are found in the extreme fundus periphery and anterior chamber angle. It was described by Brockhurst et al and Schepens, as peripheral uveitis. It is also known as chronic cyclitis or chronic posterior cyclitis. Indirect ophthalmoscopic examination and gonioscopic examination of the angle of the anterior chamber are mandatory for arriving at the diagnosis.
| Methods and material|| |
Records of all the in patients and out patients seen by the author over the last 7 years were reviewed to collect the following statistical details.
Obsevation and comments:
A total of 14 eyes in 11 patients were diagnosed to be suffering from this form of peripheral uveitis. Males were predominantly affected (63%). 63% of the patients were under 40 years of age, the mean average age being 34.9 years. It was bilateral in 27% of the patients.
5 of the affected eyes had mild ocular symptoms such as floaters, slight blurring of vision etc. More serious symptoms such as severe loss of vision, photophobia, pain, circumciliary redness etc. indicative of severe form of the disease were noted in 9 out of the total of 14 eyes involved. It was a chronic smouldering disease in 13 eyes. More than 50% of the patients have had a over 6 months follow up. Anterior segment signs of uveitis such as flare, cells and KPs were present in 10 out of the total of 14 eyes. This is contrary to views expressed by the authorities in this field. The ocular tension was normal in 11, raised in 1 and below 10mm. of Hg in 2 eyes. Fundus examination after dilatation with indirect ophthalmoscope revealed vitreous haze in 8 e5 es. There was peripheral vascular sheathing. The extreme peripheral retina, and particularly the pars plana region showed yellowish white inflammatory exudation in 6 eyes. In such cases there was evidence of excessive vitreous turbidity and cellular reaction adjascent to the inflamed area. In the later stages of the disease when inflammation had quietened down, there was whitish gliosis in the form of irregular mounds in the extreme peripheral retina obliterating the ora serrata. The vitreous was clear adjascent to such healed lesions. There was irregular pigmentation in the area of peripheral retina, ora serrata and pars plana. The inferior quadrant was involved in 13 eyes out of the total of 14 in this series.
In those cases where diagnosis could be established with certainity in one eye, the fellow eye was found to be normal only in 3 cases, iridocyclitis in 2, vitreous hemorrhage in 1 and phthisis bulbi in I eye, were the features noted in the other fellow eyes.
As complication of the peripheral uveitis, posterior subcapsular cataract was seen in 4 eyes. Contrary to opinions expressed in the literature posterior synechiae were seen in 3 eyes. However, the complications observed in posterior segment are more important and pose a serious threat to vision. Blurred disc margin in 2 and macular oedema and degeneration in 3 eyes were noted. Retinal detachment as a sequalae to posterior uveitis was seen in 2 eyes. Spontaneous reattachment of retina was observed in 1 case. Vitreous membranes causing traction leading to detachment or vitreous hemorrhage were seen in the late stages of the disease. Fluffy inflammatory snow ball lesions in the vitreous were seen in a few eyes.
In 6 patients, uveitis survey to find the incriminating aetiological agent was done. In four patients the tests were negative. In one the "C" reactive protein was positive and in another eosinophilic lung was detected on radiological examination.
The treatment consisted of topical steroids and atropine. In a few cases subconjunctival depot hydrocortisone acetate was given once a month. In a few patients large doses of systemic steroids such as prednisolone 60 mgs. per day was administered for a short period and tapered off gradually to a maintainance dose. In three patients transconjunctival cryo therapy overlying the inflamed area was given. Tne vigorous treatment pursued resulted in improvement of vision in 3 eyes.
Transconjunctival cryo therapy, under retrobuibar anaesthesia, of the inflammed areas and the adjacent areas of the retina and pars plana had very satisfactory and beneficial effect of transforming the actively inflamed area into a healed chorio-retinal scar over a period of two weeks. The topical and systemic steroids could thereafter be reduced and stopped.
| Conclusions|| |
- Pars planitis, a rare form of peripheral uveitis, occurs in the Indian population as well.
- Indirect ophthalmoscopic and gonioscopic examination are mandatory in arriving at the diagnosis.
- Contrary to opinions expressed in the literature, anterior segment signs such as flare, cells, Kp's, and posterior synechiae do occur.
- In any case of smouldering chronic granulomatous uveitis, papillitis and macular oedema, pars planitis should be suspected.
- Transconjunctival cryo therapy results in healing of the inflamed area.
| References|| |
Brockhurst, R.J., Schepens, CL.., and Okamura, I.D., 1956, Uveitis, I., Gonioscopy, Amer. J. Ophthal., 42, 545-554.