Vitreous Analysis in the Management of Uveitis

Abstract

A correct diagnosis of uveitis is often challenging, given the wide range of possible underlying conditions and the lack of typical phenotypes. Management decisions may be difficult in view of the risk of visual loss with either inappropriate or delayed therapy. Analysis of the vitreous may therefore be used to provide the clinician with valuable information. In this paper, we describe the main clinical situations in which vitreous sampling is indicated and provide some guidance to clinicians for tailoring their requests. These situations include suspected intraocular infection and suspected intraocular malignancy. We describe the principal tests carried out on vitreous samples, including cultures, polymerase chain reaction-based testing, and cytokine analysis. Limitations of the tests used are likely to become less as more advanced testing methods are introduced. The importance of selecting the appropriate investigations to support a clinical suspicion is emphasised, as is the interpretation of test results within a clinical context.

Heavy Silicone Oil and Intraocular Inflammation

“…The “PVR soup” consists of the aqueous humor containing growth factors and cytokines [27]; it tends to settle at the level of the inferior retina and posterior pole because of gravity [28]. This situation is common in complicated retinal detachment, but it is amplified after invasive surgery and by the use of intraocular tamponades that float over a subtle film of liquid where the inflammatory cytokines and growth factors reach the critical concentration over the inferior retina.…”

Uveitis in adults: What do rheumatologists need to know?

“…However, it incorporates data from more recent studies and the opinions of experts pointing to underestimation of sarcoidosis by chest radiography and to the usefulness for this diagnosis of chest computed tomography, nuclear imaging techniques, and bronchoalveolar lavage [15]. In addition, our strategy involves anterior chamber paracentesis or vitrectomy in patients with suspected lymphoma or severe treatment-resistant uveitis [16,17].…”

Uvéites de l’adulte : que doit savoir le rhumatologue ?

“…Cette stratégie s'apparente à la démarche diagnostique proposée par Harper en 2002 [14] et intègre les conclusions d'études plus récentes ou les avis d'experts, qui suggèrent la sous-estimation des cas de sarcoïdose par la radiographie pulmonaire et l'intérêt de la tomodensitométrie thoracique, de l'imagerie nucléaire, et du lavage broncho-alvéolaire pour le diagnostic de sarcoïdose [15]. De plus, la stratégie propose une ponction de chambre antérieure ou une vitrectomie en cas de suspicion de lymphome oculaire ou d'uvéites sévères résistantes au traitement [16,17].…”