Uveitis Guy by Eduardo Uchiyama, MD, FACS

07/02/2025

I’m pleased to share that we’ve launched a new two-year Vitreoretinal Surgery Fellowship at the Retina Group of Florida, beginning July 2026.

The fellowship offers high surgical volume, strong medical retina and uveitis training, and close mentorship from 15 fellowship-trained retina surgeons, based in Fort Lauderdale and Palm Beach.

We will train one fellow every two years.
Please share with any trainees interested in retina. Link in my bio.

06/14/2024

I had the honor of representing the 2014 Mass Eye and Ear and Harvard Ophthalmology graduates at the 2024 Annual Meeting and Alumni Reunion, which celebrated the 200th anniversary of Mass Eye and Ear. The training I received at Mass Eye and Ear changed my life and directly impacted the lives of thousands of patients in my South Florida community, and I will always be grateful.

07/26/2022

Sub-Tenon's injection of triamcinolone

This picture shows a patient’s eye 4 weeks after receiving triamcinolone in the subtenon’s space.

I use a 5 cc syringe with a 20 gauge needle and draw about 1.5 ml of Triamcinolone (Kenalog). I then let the syringe sit with the needle pointing up for 5-10 minutes, so the triamcinolone settles down. Then I push out about 0.7 ml of the solvent, and I end up with about 0.8 ml of concentrated triamcinolone.

I use proparacaine or tetracaine to numb the eye, place a lid speculum, ask the patient to look down, and before injecting, I “paint” the injection site with a Q-tip soaked in betadine.

I inject superiorly, as far as possible from the limbus, with a 27 gauge needle traveling tangentially to the superior limbus.

I learned this technique during my uveitis fellowship, and it allows you to easily monitor how much triamcinolone is left at each follow-up visit. You can remove some of the triamcinolone surgically if needed.

With this technique, you inject more than 40 mg in one area. I’ve seen the triamcinolone stay there for up to 11 months.

Some patients will get ptosis, so I discuss it with them before the procedure. I also tell them they will have a white patch under their lid for a few months, so they don’t worry about seeing it in the mirror.

Subtenon’s injection of triamcinolone is an excellent way to administer local steroids, but we have data that shows that it might not be as effective as other steroid delivery methods. See the Point trial for more information.

Thorne JE et al.; The PeriOcular vs. INTravitreal corticosteroids for uveitic macular edema (POINT) Trial. Ophthalmology. 2019 Feb;126(2):283-295.

-Eduardo Uchiyama, MD, FACS

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10/27/2021

A 55 yo African American female with no significant past medical history presented with decreased vision OU for 1 week. Her vision was CF OU. She had 1+ cells in the AC and 1+ cells in the vitreous with no haze OU.

What can this be? What would you do?

More photos and info in the next post in a few days

-Eduardo Uchiyama, MD, FACS

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10/11/2021

A 65-year-old patient came for evaluation on loss of vision for over a month. The patient’s vision worsened after cataract surgery a month earlier and did not recover despite treatment with multiple drops. There was no pain, VA was LP, and IOP was 4. The other eye was normal. The patient was healthy otherwise.

Anterior segment exam showed corneal edema, endothelial plaque, contracted hypopyon, severe anterior chamber inflammation, and poor view to iris and IOL.

Ultrasound demonstrated dense vitritis and serous retinal detachment.

The patient underwent vitrectomy surgery with injections of antibiotics and antifungals. Vitreous collected is shown.

Cultures grew viridans streptococci.

Vision remained light perception.

-Eduardo Uchiyama, MD, FACS

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10/10/2021

A 65-year-old patient came for evaluation on loss of vision for over a month. The patient’s vision worsened after cataract surgery over a month earlier and did not recover despite treatment with multiple drops. There was no pain, VA was LP, and IOP was 4. The other eye was normal. The patient is healthy otherwise.

What’s your presumptive diagnosis? How would you handle it?

I’ll post more info and follow-up images in my next post.

- Eduardo Uchiyama, MD, FACS

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10/05/2021

Do NOT do a “prophylactic” peripheral iridotomy in this patient!

Posterior synechiae are a common finding in patients with a history of anterior or panuveitis.

1. When the adhesion is relatively fresh and narrow, dilating drops for a few days might resolve them. Some physicians even use pledgets soaked on dilating drops while patients wait in the clinic, and some of these adhesions can resolve too.
2. If the adhesions are broad or chronic, the use of cycloplegics is futile in most situations.
3. Once the inflammation is being treated with steroids, the risk of developing new posterior synechiae is relatively small, so there is no need to used cycloplegics for weeks.
4. Uveitis patients have a more pronounced inflammation after any ocular surgery, and that includes laser peripheral iridotomies. Do NOT perform “prophylactic” peripheral iridotomies in patients with posterior synechia unless there’s iris bombe present. The post-op inflammation developed after a “successful laser peripheral iridotomy” can be enough to close the iridotomy and create new synechiae and iris bombe.

Do NOT over-treat chronic posterior synechiae. In most situations, their presence is not visually significant, and no intervention is warranted.

Eduardo Uchiyama, MD, FACS

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09/30/2021

A 55-year-old male presented for a second opinion on his chronic unilateral uveitis. He had been treated with topical prednisolone on and off for the past two years.

On examination, the affected eye had 20/60 vision, IOP was normal, he had the dendritic lesion shown on the pictures, few fine keratic precipitates, 1+ AC cells, no iris changes, pseudophakia with no plaques, no vitreal cell/haze, and no chorioretinal lesions. The other eye had no abnormalities.

In this case, I wasn’t sure if the patient had herpetic anterior uveitis from the beginning or had autoimmune uveitis initially and later developed an opportunistic herpetic infection due to his chronic use of steroids without proper follow up.

The patient was diagnosed with herpetic keratouveitis likely caused by HSV and was started on valacyclovir 1g TID for two weeks, followed by 1 gram daily as a suppressive dose. Steroids drops were initially increased and later tapered off completely.

The patient’s corneal lesion and inflammation resolved entirely and did not recur on valacyclovir 1 g daily.

Patients with unilateral anterior uveitis should be carefully assessed for viral anterior uveitis. The classic findings include IOP elevation and iris changes, but their absence does not rule out a viral etiology.

Use fluorescein staining on your uveitis patients to rule out subtle corneal changes. Not all dendrites will be as clear and prominent as the one found in this patient.

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09/26/2021

A 30-year-old Latin American male presented with decreased vision in his right eye for the past several months. He was diagnosed with ocular toxoplasmosis over a year ago and had multiple episodes since diagnosis. He had been treated previously with numerous courses of intravitreal clindamycin and oral Bactrim DS with an excellent initial response, but he had multiple retinitis reactivation just weeks after treatment. He already had macular involvement that likely caused permanent vision loss.

On examination, his vision was 20/200, and he had AC cells, vitreous cells and haze, chorioretinal scarring, and active retinitis involving his right eye macula. A wide-field angiogram showed diffuse vascular leakage, macular edema, and staining of macular lesions.

The patient was started on Bactrim DS twice a day for about eight weeks in addition to oral prednisone. Once the disease was controlled and retinitis resolved, he was started on chronic suppressive therapy with Bactrim DS three times a week with good effect. No new episodes developed in over a year.

Most cases of ocular toxoplasmosis respond to local or systemic antibiotic therapy, and even though recurrences are common, they tend to be far apart in immunocompetent individuals. In cases when recurrences are frequent or sight-threatening, chronic suppressive antibiotic therapy can be used.

Fernandes Felix JP, et al. Long-term Results of Trimethoprim-Sulfamethoxazole Versus Placebo to Reduce the Risk of Recurrent Toxoplasma gondii Retinochoroiditis. Am J Ophthalmol 2020;213:195-202.

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09/23/2021

A 17-year-old adolescent boy presented with blurred vision for several weeks. Visual acuity was 20/400 OD and 20/20 OS. On exam, he had no AC cells and only a few vitreal cells with no haze OU. Fundus examination revealed dilated and tortuous vessels with diffuse retinal infiltrates and intraretinal hemorrhages OU, and a macular infiltrate OD.

The clinical picture was consistent with leukemic retinopathy, and urgent systemic evaluation was needed.

The patient was sent to the emergency room for stat bloodwork. The white blood cell count was 521 400 cells/μL, and a bone marrow biopsy supported a diagnosis of chronic myelogenous leukemia.

Always be on the lookout for malignancy masquerading as uveitis.

Warminski JD, Uchiyama E. Leukemic retinopathy. JAMA Ophthalmol 2015;133:73

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09/17/2021

A 75 yo male presented to the clinic for a second opinion on his chronic uveitis. He was diagnosed with Multifocal Choroiditis and Panuveitis over three years ago and was treated with pulses of systemic prednisone. The previous outside workup included a negative RPR, Quantiferon gold, and a normal chest CT with contrast.

On examination, his vision was OD 20/80 and OS 20/200. He had 0.5+ AC cells OU and evidence of vitreous cells and vitreous haze OS>OD. He also had CME OU. His fundus photos, FA, and ICG, are attached.

Repeat work-up showed positive FTA-ABS and TP-PA. His RPR remained negative.

The patient was treated with two weeks of intravenous penicillin, and his vitritis and CME resolved. His vision improved to OD 20/60 and OS 20/80 after treatment.

Patients with ocular inflammation need to have syphilis ruled out with a treponemal test such as Syphilis IgG, FTA-ABS, or TP-PA.

A negative RPR does not rule out syphilis.

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07/28/2021

Common mistakes in the management of uveitis patients

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AVOIDING COMMON MISSTEPS IS KEY TO SUCCESSFUL TREATMENT