Pars plana vitrectomy in uveitis in the era of microincision vitreous surgery

Abstract

Pars plana vitrectomy (PPV) in uveitis is indicated for various diagnostic and therapeutic indications. With the advent of microincision vitreous surgery (MIVS), the use of PPV in uveitis has increased with a wider spectrum of indications due to shorter surgical time, less patient discomfort, less conjunctival scarring, and a decreased rate of complications as compared to standard 20G vitrectomy. Because of faster post-operative recovery in terms of visual improvement and reduction of inflammation, and reduced duration of systemic corticosteroids, MIVS has gained popularity in uveitis as an adjunctive therapy to the standard of care medical therapy. The safety and efficacy of MIVS is related to the emerging vitrectomy techniques with better and newer cutters, illuminating probes, and accessory instruments. Because of the instrumentation and fluidics of MIVS, PPV is emerging as a safe and useful alternative for diagnostic challenges in uveitis, aiding in earlier diagnosis and better outcome of inflammatory disease, even in the presence of severe and active inflammation, which was once considered a relative contraindication for performing vitreous surgery. However, for surgical interventions for therapeutic indications and complications of uveitis, it is advisable to achieve an optimum control of inflammation for best results. The increasing reports of the use of MIVS in uveitis have led to its wider acceptance among clinicians practicing uveitis.

Tubercular Retinal Vasculitis: Diagnostic Dilemma and Management Strategies

“…TRV has a specific clinical picture, at least in the regions where most of the cases are reported ( Figure 1 ): it typically presents as an exudative, segmental, hemorrhagic retinal vasculitis, frequently associated with peri- or sub-vascular choroiditis, vitritis, and when more posteriorly situated, with disc and macular edema. 22 , 25 , 26 Eales disease, in contrast, typically presents a peripheral, minimally exudative, non-hemorrhagic, isolated retinal vasculitis with extensive (not segmental) swathes of pipestem-like sheathing; 15 choroiditis, vitritis, snowball exudates and macular edema are rarely associated. 27 Eales has the unusual combination of minimal inflammation with extensive vascular occlusion causing recurrent vitreous hemorrhages, and sometimes, tractional detachments.…”

“…It is well known to be treated successfully with ATT alone. 26 Corticosteroids may indeed be required, but almost never in absence of ATT. A coexistent latent, healed or active systemic TB is mandatory for the diagnosis of TRV; 20 , 22 but not for Eales disease, which is a mild primary retinal vasculitis, and does not always require treatment for its inflammatory course.…”

Protein Biomarkers in Uveitis

“…While pellet is subjected to DNA-based molecular tests, the supernatant is cryopreserved at −80°C for future research studies, including proteomics. Though the safety and efficacy of PPV is now well established in uveitis in the era of MIVS (84,85), their contribution toward proteomic quality of vitreous samples is yet to be addressed. Sampling of aqueous humor in uveitis is indicated in anterior uveitis, or in cases where PPV is not indicated.…”

Outcomes of Primary 27-Gauge Vitrectomy for 73 Consecutive Cases With Uveitis-Associated Vitreoretinal Disorders

“…However, the surgical stress associated with PPV increases the risk of intraoperative and post-operative complications in inflamed eyes (7,12,13). Therefore, balancing benefits with risks has become the primary concern when performing PPV for uveitis (12,14,15). The microincision vitrectomy system (MIVS), first appeared as 25-gauge PPV, was developed nearly two decades ago (16) and has gradually become the standard surgical platform for various indications, including uveitis-related vitreoretinal disorders (8,9).…”