title: Diagnostic pars plana vitrectomy and aqueous analyses in patients with uveitis of unknown cause.
abstract: OBJECTIVE
  To compare the yield of diagnostic pars plana vitrectomy (PPV) with the yield of aqueous analyses in patients with uveitis of unknown cause.
  
  
  METHODS
  Seventy-five consecutive patients (84 eyes) with uveitis involving posterior eye segment who undergo a diagnostic PPV from 2005 through 2009 were retrospectively reviewed. Vitreous specimens were simultaneously analyzed by microbiological culture, flow cytometry, and cytology as well as by polymerase chain reaction and for intraocular antibody production by Goldmann-Witmer coefficient. In 53 eyes, both aqueous and vitreous samples were assessed. The primary outcome measure was the comparison between vitreous and aqueous analyses.
  
  
  RESULTS
  Vitreous analysis was positive in 18 of 84 eyes (21%). Positive results indicated infectious uveitis in 12 of 18 cases (67%) and lymphoma in 6 of 18 (33%) cases. Of the 53 eyes with both aqueous and vitreous samples available, aqueous analysis revealed the diagnosis in 6 of 53 eyes and vitreous in 9 of 53 eyes. Unilateral uveitis (P = 0.022), panuveitis and uveitis posterior (P ≤ 0.001), preoperative immunosuppressive therapy (P = 0.004), and increasing age (P = 0.018) were associated with an increased diagnostic yield of PPV. Overall, 1 year after PPV, median visual acuity improved from 20/200 to 20/80 (Snellen, P ≤ 0.001). Of 18 patients who were on immunosuppressive treatment before PPV, 8 (44%) were able to stop immunosuppressive therapy during 1-year follow-up. The complications of PPV consisted predominantly of cataract development (33/65, 51%).
  
  
  CONCLUSIONS
  Diagnostic PPV with the analysis of vitreous fluid by multiple laboratories for infectious and malignant disorders was useful in diagnosing uveitis of unknown cause. Previous aqueous analysis was especially valuable for the diagnosis of intraocular infections and may therefore decrease the number of patients who would otherwise undergo an invasive diagnostic PPV. Furthermore, PPV was associated with improved visual acuity and decreased use of immunosuppressive therapy.
authors.affiliation: *Department of Ophthalmology and †Department of Virology, University Medical Centre Utrecht, Utrecht, The Netherlands; and ‡Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Abdelkarim
authors.initials: A
authors.lastname: Oahalou
authors.forename: Peter A W J F
authors.initials: PA
authors.lastname: Schellekens
authors.forename: Jolanda D
authors.initials: JD
authors.lastname: de Groot-Mijnes
authors.forename: Aniki
authors.initials: A
authors.lastname: Rothova
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000913:Antibodies, Protozoan / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D001082:Aqueous Humor / Q000276:immunology / Q000382:microbiology*; D001431:Bacteriological Techniques; D015818:Eye Infections, Bacterial / Q000175:diagnosis*; D005134:Eye Neoplasms / Q000175:diagnosis*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008223:Lymphoma / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015866:Uveitis, Posterior / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000276:immunology / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D000914:Antibodies, Viral; D007166:Immunosuppressive Agents