The role of pars plana vitrectomy in the diagnosis and treatment of uveitis.
OBJECTIVE
To assess the diagnostic yield of vitreous fluid analysis and the therapeutic effect of pars plana vitrectomy in patients with suspected intraocular inflammation.


METHODS
During 2004-2008, pars plana vitrectomy was performed in 89 patients (101 eyes) out of 1233 patients with uveitis. Vitreous specimens were analyzed by cytologic and histopathologic examination, microbiologic culture, polymerase chain reaction, antibody determination, and flow cytometry. Vitrectomy was performed in 85 eyes for both diagnostic and therapeutic purposes; the remaining 16 eyes underwent only diagnostic pars plana vitrectomy. Preoperative and postoperative best-corrected Snellen visual acuity was compared.


RESULTS
Preoperative diagnoses were infection in 40 patients, malignant masquerade syndrome in 10 patients, and idiopathic uveitis in 39 patients. Vitreous analysis contributed to the determination of diagnosis in 54 patients (61%). Final diagnoses were infection in 42 patients, malignant masquerade syndrome in 6 patients, benign masquerade syndrome in 16 patients, and idiopathic uveitis in 25 patients. Vitreous fluid collected from each eye underwent approximately 2.2 (range 1-6) laboratory tests. Therapeutic reasons for vitrectomy were the treatment of complications of uveitis in 42 eyes and/or intravitreal application of anti-infectious or cytostatic drugs in 49 eyes. Overall, the visual acuity improved in 45% of eyes, remained unchanged in 45% of eyes, and decreased in 10% of eyes in 3 months after surgery.


CONCLUSIONS
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.
Svozilkova
Petra
P
Department of Ophthalmology, First Faculty of Medicine, Charles University in Prague, General University Hospital in Prague, Czech Republic. petra.svozilkova@lf1.cuni.cz
Heissigerova
Jarmila
J
Brichova
Michaela
M
Kalvodova
Bohdana
B
Dvorak
Jan
J
Rihova
Eva
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000981:Antiprotozoal Agents / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage; D002648:Child; D004396:Coloring Agents; D015817:Eye Infections / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D005434:Flow Cytometry; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D014605:Uveitis / Q000175:diagnosis* / Q000188:drug therapy*; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D014822:Vitreous Body / Q000276:immunology / Q000382:microbiology / Q000473:pathology*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000981:Antiprotozoal Agents; D000998:Antiviral Agents; D004396:Coloring Agents; D007208:Indocyanine Green