Assessment of diagnostic and therapeutic vitrectomy for vitreous opacity associated with uveitis with various etiologies

Abstract

Vitreous opacity (VO) is a common feature of intermediate uveitis, posterior uveitis, and panuveitis. Fundus observation is critical for determining the etiology of uveitis, however, is often interfered with VO. In these clinical settings, vitrectomy contributes to a correct diagnosis and guides alternative management strategies. The purpose of this study was to evaluate the diagnostic yield and surgical outcome of vitrectomy in uveitic patients with VO and compare the visual outcome between infectious and noninfectious uveitis. Forty-five eyes with uveitis-associated VO underwent diagnostic and therapeutic vitrectomy, and etiological diagnosis of uveitis was confirmed in 34 of 45 eyes (75.6%). The diagnoses were infectious uveitis in 13 eyes (28.9%), noninfectious uveitis in 21 eyes (46.7%), and unidentified uveitis in 11 eyes (24.4%). Visual acuity (VA) improvement rates at 6 months after surgery were 69.2%, 76.2%, and 90.9% in the infectious, noninfectious, and unidentified uveitis groups, with no significant difference among 3 groups. Significant decrease in inflammation score after vitrectomy was observed only in the infectious uveitis group. This study demonstrated that diagnostic vitrectomy for inflammatory eyes with VO of unknown etiology was effective in infectious and noninfectious uveitis, and the therapeutic effect of VA improvement was observed in both types of uveitis.

<p>Clinical Features of Japanese Patients with Ocular Inflammation and Their Surgical Procedures Over the Course of 20 Years</p>

“…8,[18][19][20] For vitrectomy, about 50% of patients had vitreous opacity, and malignant lymphoma and sarcoidosis seemed to be the underlying diseases, although vitrectomy for inflammatory eyes with vitreous opacity of unknown etiology has been reported. 21 In the present study, the mean VA was significantly improved after vitrectomy, but 14.2% of patients required the reoperation, which seems a high incidence. In our study, fungal endophthalmitis was observed in 25 patients, which seemed higher.…”

Management of presumed trematode-induced granulomatous intermediate uveitis

“…The role of PPV in the management of IU has been reported by many authors before whether as a diagnostic or a therapeutic procedure and was associated with a decrease in the severity of inflammation, recurrence rate and the need for immunosuppressives postoperatively [22][23][24]. The surgery is commonly performed as a therapeutic approach in uveitic cases complicated by epimacular membrane, TRD, rhegmatogenous retinal detachment and vitreous hemorrhage [21].…”

“…The surgery is commonly performed as a therapeutic approach in uveitic cases complicated by epimacular membrane, TRD, rhegmatogenous retinal detachment and vitreous hemorrhage [21]. Yet, even in the absence of these complications, PPV was also found to be beneficial in improving visual activity and decreasing inflammation in cases of persistent vitreous opacities despite full systemic medical therapy [22,23]. In cases of noninfectious IU, it has been suggested that vitrectomy may be effective in improving vitreous inflammation by removing the antigenic load and reducing the levels of cytokines and interleukins that activate the inflammatory cascade [23][24][25].…”

Intermediate Uveitis

“…It gives the additional advantage of potentially confirming a diagnosis. In a mixed series of infectious and noninfectious uveitis, a diagnosis was reached following vitreous analysis with culture, PCR, and cytokine analysis in 34 of 45 eyes (75%) [221]. Vision improved following vitrectomy in most eyes.…”