Pars planitis: epidemiology, treatment, and association with multiple sclerosis

Abstract

During retrospective and prospective studies, we attempted to determine the clinical characteristics, treatment, and visual outcome of patients with pars planitis and to evaluate the association between pars planitis and multiple sclerosis (MS). The retrospective study included 44 patients with pars planitis, who had been examined between October 1986 and January 1999. We analyzed age, sex, visual acuity (VA), median follow-up time, and medical and surgical treatments. The prospective study, which included 21 consecutive patients with pars planitis, was performed to determine the presence of MS. In the retrospective study, the mean patient age was 22.4 years (SD +/- 11.5) and the median follow-up was 34.9 months (SD +/- 27.2). Complications included macular edema (47.7%), vitreous opacities (38.6%), papillitis (38.6%), vasculitis (36.4%), and cataract (20.5%). Forty patients (90.9%) had a final bilateral VA better than 20/40. In the prospective study, magnetic resonance imaging (MRI) was performed. Demyelinating lesions were found in 10 (47.6%) of the 21 patients and relapsing-remitting clinically definite MS was diagnosed in seven (33.3%). With the exception of age, no significantly statistical differences were observed when the visual prognosis and the clinical and epidemiologic characteristics were compared between the two groups of patients with and without associated MS; a diagnosis of MS was more frequently made in patients over 25 years of age. With appropriate treatment, patients with pars planitis have a good visual prognosis. Because the presence of demyelinating lesions seems to be high among patients with pars planitis, MRI should be considered, especially in patients over 25 years of age.

Uveitis and neurologic diseases: an often overlooked relationship

“…In our patient population, uveitis was typically of the granulomatous type, bilateral and located at either the anterior or intermediate regions of the eye, leading to dense vitreous opacifications, retinal periphlebitis, intraretinal hemorrhages and retinal vascular proliferations, thus forming a literally pathognomonic clinical picture. MS-associated uveitis seems to respond very well to interferon therapy, and therefore early diagnosis could spare the patient sight-threatening complications [18][19][20][21].…”

Management of uveitis

“…Pars planitis is a bilateral intermediate uveitis that generally runs a chronic course [24,25]. Clinical examination 24 reveals the diagnostic snowbank (collection of inflammatory debris on the inferior pars plana).…”

Risk of cataract and glaucoma in patients with multiple sclerosis

“…The combination of MS disease with cataract or glaucoma might even be of greater impact on these patients compared with those who suffer from one of the diseases, especially as most MS patients are of relatively young age. Because the relative risk of cataract or glaucoma in patients with MS as compared with population-based controls has not been studied, 3,4,21 the objective of our study was to evaluate whether MS increases the risk of cataract or glaucoma.…”

“…2 The rate of MS in patients with pars planitis has been reported to be higher (12-33%) than in the general population. 3,4 Cataract is the leading cause of visual impairment in the world and poses a huge burden on the patient. It is characterized by a partial or total opacity of the crystalline intraocular lens.…”