uveitis - mercyhealth · pdf fileintermediate uveitis or pars planitis is when the middle...
TRANSCRIPT
![Page 1: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/1.jpg)
Uveitis
![Page 2: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/2.jpg)
What is the uvea?
! a highly vascularized section of the eye beneath the sclera
! Supplies most of the ocular structures with nutrients
! via the anterior and posterior branches of the ophthalmic artery
![Page 3: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/3.jpg)
Uvea
![Page 4: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/4.jpg)
Uvea
! made up of the iris, ciliary body and choroid
! iris controls the amount of light entering the eye
! the ciliary body produces aqueous humor and controls the outflow by contracting and widening the trabecular meshwork
![Page 5: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/5.jpg)
UVEA
! The choroid provides nourishment to the outer retinal layers and absorbs excess light
![Page 6: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/6.jpg)
Uveitis
! Inflammation of any of these structures is called uveitis
! synonym of uveitis is iritis, which is more anatomically specific
! Yet terms are used interchangeably
![Page 7: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/7.jpg)
NONGRANULOMATOUS ANTERIOR UVEITIS
! most common form of uveitis
! can present as bilateral or unilateral, chronic, or acute, idiopathic, infectious, immunological, or neoplastic
![Page 8: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/8.jpg)
CLASSIC SYMPTOMS
! Redness
! Extreme photophobia
! Pain often described as a dull ache or a headache in the eye and becoming a sharp pain with change in lighting
![Page 9: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/9.jpg)
SYMPTOMS IN CHRONIC DISEASE
! Symptoms may be absent and only clinical signs present
![Page 10: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/10.jpg)
DETERMINING THE CAUSE
! A good medical and ocular history can reveal the cause
! Lab testing is necessary in repeat cases with no obvious underlying systemic cause
! sometimes the cause is unknown
! 38% of cases are idiopathic
![Page 11: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/11.jpg)
CLINICAL SIGNS
! red eye with circumlimbal flush
! pupil may be mid-dilated
! cells in the anterior chamber, to see slit lamp must be on high mag with brightest light narrow small beam used
! flare may or may not be present
![Page 12: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/12.jpg)
CILIARY FLUSH
![Page 13: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/13.jpg)
ANTERIOR CHAMBER CELLS
![Page 14: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/14.jpg)
DIAGNOSIS
! anatomy involved determines the diagnosis
! if cells and inflammation are only in the anterior chamber than it is anterior uveitis or iritis
! cells also in the vitreous it is iridocyclitis
! only ciliary body involved - cyclitis
![Page 15: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/15.jpg)
DIAGNOSIS
! INTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed
! white blood cells collect in the inferior portion of the retina looks like snow banks
![Page 16: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/16.jpg)
PARS PLANITIS
![Page 17: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/17.jpg)
DIAGNOSIS
! Posterior uveitis- the retina, choroid, vitreous, and sometimes sclera are inflamed
! Pan-uveitis involves the entire uvea and surrounding tissue
![Page 18: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/18.jpg)
RISK
! the further back the uveitis proceeds in the eye
! the more likely it is associated with systemic disease
! the more difficult it is to treat
! the greater the risk of complications
![Page 19: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/19.jpg)
TYPES OF UVEITIS
! Granulomatous more severe
! iris granulomas
! Koeppe nodules on the pupillary margin
! Busacca nodules in the iris stroma
! Keratic precipitates KPs on the endothelium that are large, globular and greasy known as mutton fat KPs
![Page 20: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/20.jpg)
Koeppe Nodules
![Page 21: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/21.jpg)
BUSACCA NODULES
![Page 22: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/22.jpg)
MUTTON FAT KPS
![Page 23: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/23.jpg)
HYPOPYON
! may form if the inflammation is not treated
![Page 24: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/24.jpg)
HYPOPYON
![Page 25: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/25.jpg)
COMMON GRANULOMATOUS
UVEIITEDES
! Tuberculosis, Lyme’s disease, and Sarcoidosis
![Page 26: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/26.jpg)
NON-GRANULOMATOUS
! Less severe
! smaller KPs, fewer iris nodules, less likelihood of forming synechiae
![Page 27: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/27.jpg)
HISTORY
! Thorough history and careful slit lamp examination can lead to the correct diagnosis even before blood work
! 38 percent of cases are idiopathic
![Page 28: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/28.jpg)
NON-GRANULOMATOUS
! First episode of unilateral uveitis
! Blood work does not need to be done
! IF additional episodes occur and a cause has not been determined, blood work is necessary to find the underlying cause
![Page 29: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/29.jpg)
LABS
! Complete blood count with differential CBC-
! gives a general look at their health status
! can help with diagnosis of leukemia, infection and anemia
![Page 30: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/30.jpg)
C-REACTIVE PROTEIN
! marker for inflammation
! does not pinpoint location of inflammation
![Page 31: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/31.jpg)
ERYTHROCYTE SEDIMENTATION RATE
! Detects inflammation
! Used in conjunction with CRP
![Page 32: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/32.jpg)
ANTINUCLEAR ANTIBODY
! Checks for certain autoimmune disorders
! Lupus, scleroderma, juvenile arthritis polymyositis, IBS, psoriasis
![Page 33: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/33.jpg)
RHEUMATOID FACTOR
! Helps to diagnose rheumatoid arthritis and Sjogren’s
![Page 34: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/34.jpg)
RAPID PLASMA REGAIN
! Used to screen for syphilis
! can be thrown off by Lyme’s, connective tissue disease, pregnancy and viral infections
! + RPR confirmed with Fluorescent treponemal antibody absorption test
![Page 35: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/35.jpg)
ANGIOTENSIN CONVERTING ENZYME
! Used to diagnose sarcoidosis and helps to monitor the disease
![Page 36: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/36.jpg)
Chest X-ray
! when looking for sarcoidosis or TB
! Usually ordered if other lab work and clinical exam indicate the necessity
![Page 37: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/37.jpg)
HLA-B27
! Human Leukocyte B27
! found on the surface of white blood cells and is associated with a number of auto-immune diseases
! Reiter syndrome and ankylosing spondylitis
! can sometimes be the sole determining factor in some uveitis cases
![Page 38: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/38.jpg)
PURIFIED PROTEIN DERIVATIVE
! PPD checks for latent Tuberculosis
![Page 39: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/39.jpg)
LYME TITER
! and Enzyme linked immunosorbent assay together with anti-Borellia burgdorferi immunoglobulins M and G are used to detect the presence of LYME disease
![Page 40: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/40.jpg)
TREATMENT
! First, unilateral non-granulomatous are idiopathic, due to a viral or sinus infection, or due to trauma
! lab testing not needed, treat and observe
! If the traumatic uveitis is mild, it does not need treatment
![Page 41: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/41.jpg)
TREATMENT GOALS
! Decrease Pain
! prevent posterior synechiae and therefore pupillary block
! prevent peripheral anterior synechiae and angle closure
! Re-establish the blood-aqueous barrier
![Page 42: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/42.jpg)
CYCLOPLEGICS
! important to all four goals
! act on the vasculature to stabilize the blood aqueous barrier, preventing further leakage
! Decreases pain by immobilizing the iris
! helps to prevent synechiae formation
![Page 43: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/43.jpg)
CORTICOSTEROIDS
! reduce the body’s inflammatory response, reduce capillary permeability and vasodilation
![Page 44: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/44.jpg)
SURGICAL OPTIONS
! Peripheral iridotomy or periocular implant
![Page 45: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/45.jpg)
TREATMENT
! Initial dose of steroids should be frequent to knock down the inflammation quickly and then tapered slowly so rebound inflammation does not occur
! common mistake practitioners make is not starting the steroids frequently enough
! exception is in traumatic uveitis
! Short course- no tapering- trauma is gone
![Page 46: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/46.jpg)
TREATMENT COMPLICATIONS
! Increased IOP and posterior subcapsular cataracts
! Increased IOP my not be from the steroid
! usually in iritis the IOP is lower but it can be higher
![Page 47: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/47.jpg)
OTHER CAUSES FOR INCREASED IOP
! Clogging of trabecular meshwork with inflammatory cells
! Trabecullitis, inflamed, swollen meshwork fibers
! Posterior synechiae or peripheral anterior synechiae
! Sick eye returning to normal
![Page 48: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/48.jpg)
REASONS FOR LOWER ���IOP
! Increase in the endogenous prostaglandins augments uveoscleral outflow
! decrease in aqueous humor production by the inflamed ciliary body
![Page 49: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/49.jpg)
TREATING THE ELEVATED IOP
! treat with an aqueous suppressant
! Beta blocker, carbonic anhydrase inhibitor
! do not use prostaglandin analogs or miotics they can increase inflammation
! miotics increase the risk for synechiae formation
![Page 50: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/50.jpg)
Treating Anterior Uveitis
! One drop of 1% prednisolone acetate every 2 hours for several days or until the cells in the anterior chamber are less than grade 2
! Then planned tapering-- VERY important to taper if the steroid is dropped to quickly the patient will have a rebound inflammation
![Page 51: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/51.jpg)
Severe Cases
! Durezol can be used qid or q2h
! Oral steroids may be needed in severe cases or a steroid injection into the eye
![Page 52: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/52.jpg)
Cycloplegics
! 5% homatropine bid or atropine bid for several days
![Page 53: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/53.jpg)
Intermediate and Posterior Uveitis
! If mild, can be treated with durezol
! More severe cases may require a steroid implanted into the back of the eye
![Page 54: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/54.jpg)
Steroid Implants
! Retisert - Fluocinolone acetonide - the drug reservoir is inserted into the sclera and can last 2.5 years
! Side effects, increased IOP, cataract progression, and eye pain
![Page 55: Uveitis - Mercyhealth · PDF fileINTERMEDIATE UVEITIS or Pars planitis is when the middle portion of the ciliary body is inflamed!!](https://reader030.vdocument.in/reader030/viewer/2022011800/5abe70f67f8b9a5d718cfc26/html5/thumbnails/55.jpg)
Steroid Implants
! Ozurdex- dexamethasone- allergan
! Implanted transconjunctivally