The Role of Pars Plana Vitrectomy in the Diagnosis and Treatment of Uveitis

Abstract

Pars plana vitrectomy with carefully selected testing is a valuable tool for assessment of diagnosis in a large proportion of patients with uveitis. Moreover, the therapeutic effect of vitrectomy can improve the visual outcomes in these patients.

Practical diagnostic approach to uveitis

“…Additional studies are required for diagnosis of masquerade syndromes and should be dictated by the clinical presentation and findings on examination. These may include vitreous biopsy, lumbar puncture and evaluation of cerebrospinal fluid, brain imaging with MRI or full-body CT, or PET-CT [11].…”

“…Endogenous endopthalmitis often is suspect when there are risk factors such as recent bowel perforation or surgery, indwelling lines, intravenous drug use or known recent infections elsewhere. If endogenous endophthalmitis is suspected, vitreous sampling with culture and potentially with molecular diagnostics is indicated [11]. If there is no prior history of trauma or eye surgery then echocardiography, CXR and blood cultures should also be performed.…”

“…If the answer is yes, then the treatment path is clarified. If the specific syndrome is elusive, one must take the appropriate steps to try to define the underlying pathophysiology, whether it be autoimmune, infectious, neoplastic or other masquerade syndromes, as the appropriate treatment for these types of diseases vary widely [4][5][6][7][8][9][10][11][12][13][14].…”

Cytopathology of Vitreous Humor Samples in Routine Practice

“…Vitrectomy can also be used as a diagnostic tool in cases of clinically undiagnosed uveitis or uveitis with an atypical clinical course, suspected infectious endophthalmitis or suspicion of intraocular malignancy [3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]. In these cases, cytological analysis combined with appropriate ancillary testing, such as microbiological analysis, flow cytometry and interleukin (IL) measurement, is a valuable tool that can lead to a final clinical diagnosis in most cases [8].…”

“…Specific vitreous diseases are thus rarely encountered in the routine practice of cytopathologists. Moreover, the vast majority of cytological studies have focused on the distinction between chronic uveitis and primary intraocular lymphoma [4,5,6,8,9,10,11,19]. Only a few studies have described nonneoplastic cytology and routine cytology of vitreous samples [3,12,13,14,15,16].…”