Long-Term Follow Up of Presumed Trematode Induced Granulomatous Intermediate Uveitis: Predictors for Failure of...

To identify predicators of medical treatment failure in patients with presumed trematode induced granulomatous intermediate uveitis (PTIGIU).

A retrospective review of the medical records of children diagnosed with PTIGIU over a 4-year period was conducted. Main outcome measures included the management options and treatment outcomes.

98 eyes of 90 patients clinically diagnosed with PTIGIU were initially reviewed with a minimum follow up of 2 years. Mean age was 11 ± 2.38 years and 96.9% were males. All patients reported a history of freshwater exposure with a mean exposure to presentation time of 3 ± 2.822 weeks. UBM detected CB granuloma and confirmed the diagnosis in 53 eyes, 27 of which had an associated AC granuloma. Management options included surgical intervention in the form of parsplana vitrectomy ± lensectomy, or conservative management with systemic, topical or periocular steroids. Surgical interventions were done in 30 eyes, 20 of which had initially received conservative management that subsequently failed and required surgery. Univariate logistic regression revealed that CDVA, degree of vitreous/AC inflammation and lens status at initial presentation were significant predictors for surgical intervention (p < 0.001, 0.008, 0.005 and <0.001 respectively). CDVA, vitritis and degree of AC inflammation were also associated with failure of initial conservative management (p = 0.008, 0.005 and 0.009 respectively).

Various management options exist for patients with PTIGIU, but patients with lower presenting vision and higher degrees of vitreous inflammation respond better to surgical intervention than medical therapy alone.