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Mazzeo TJMM, Cristina Mendonça Freire R, Guimarães Machado C, Gomes AMV, Curi ALL. Vitreoretinal Surgery in Uveitis: From Old to New Concepts - A Review. Ocul Immunol Inflamm 2024; 32:740-753. [PMID: 37093650 DOI: 10.1080/09273948.2023.2193842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/16/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The aim of this article is to do a comprehensive literature review about the current role of pars plana vitrectomy in uveitis and in its different structural complications such as cystoid macular edema, epiretinal membrane, macular hole, and retinal detachment. METHODS This comprehensive literature review was performed based on a search on PubMed, BioMed Central, Science Open, and CORE databases, of relevant articles abording pars plana vitrectomy in uveitis. DISCUSSION Uveitis is a complex disease with multiple etiologies and pathogenic mechanisms. Therapeutic pars plana vitrectomy (PPV) may aid in uveitic structural complications such as cystoid macular edema, epiretinal membranes, macular hole, and retinal detachments even though some cases may present unpredictable visual outcomes. Diagnostic PPV with appropriate ancillary testing is also a valuable tool for the assessment and diagnosis of uveitis in a large proportion of patients. CONCLUSION Over the years, pars plana vitrectomy has undergone significant transformations since its invention nearly 5 decades ago, however, the quality of evidence in the literature regarding its use for uveitis has not improved in the same way. Even though some structural uveitis complications (as previously mentioned) may respond well to surgery, there is still a certain unpredictability regarding its visual outcomes. On the other hand, diagnostic vitrectomy with appropriate ancillary testing is also a valuable tool for the assessment and diagnosis of uveitis in a large proportion of patients.
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Affiliation(s)
| | | | - Cleide Guimarães Machado
- Retina and Vitreous Department, Suel Abujamra Institute, São Paulo, Brazil
- Retina and Vitreous Department, University of São Paulo (USP), São Paulo, Brazil
| | | | - André Luiz Land Curi
- Clinical Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases (INI - Fiocruz), Rio de Janeiro, Brazil
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El Faouri M, Ally N, Lippera M, Subramani S, Moussa G, Ivanova T, Patton N, Dhawahir-Scala F, Rocha-de-Lossada C, Ferrara M, Jalil A. Long-Term Safety and Efficacy of Pars Plana Vitrectomy for Uveitis: Experience of a Tertiary Referral Centre in the United Kingdom. J Clin Med 2023; 12:jcm12093252. [PMID: 37176692 PMCID: PMC10179292 DOI: 10.3390/jcm12093252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
AIM To evaluate the effectiveness of pars plana vitrectomy (PPV) without macular intervention on uveitis eyes with persistent vitreous inflammation/opacities in terms of visual acuity (VA), intraocular inflammation and macular profile. METHODS We carried out a single-center retrospective study of patients with uveitic eyes that underwent PPV without intervention on the macula due to persistent vitreous inflammation/opacities. The primary outcome measures were best-corrected visual acuity (BCVA), intraocular inflammation and macular profile at 3, 12 and 24 months after surgery. RESULTS Twenty-seven eyes of twenty-six patients were analyzed. Overall, 77.8% had an improvement of VA (55% by 0.3 LogMAR or more); 62.5% of patients had no intraocular inflammation, and the number of patients on systemic steroids and second-line immunosuppressives was reduced by 26% at 12 months; 87.5% of patients had resolution of macular oedema at 12 months. CONCLUSION PPV for persistent vitreous inflammation/opacities is safe and effective, showing beneficial outcomes in terms of improvement of BCVA and the reduction in inflammation.
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Affiliation(s)
- Muhannd El Faouri
- Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WL, UK
- Faculty of Medicine, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
| | - Naseer Ally
- Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WL, UK
| | - Myrta Lippera
- Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WL, UK
| | | | - George Moussa
- Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WL, UK
| | - Tsveta Ivanova
- Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WL, UK
| | - Niall Patton
- Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WL, UK
| | | | - Carlos Rocha-de-Lossada
- Qvision, Opththalmology Department, VITHAS Almería Hospital, 04120 Almería, Spain
- Ophthalmology Department, VITHAS Málaga, 29016 Málaga, Spain
- Regional Universityu Hospital of Malaga, Plaza del Hospital Civil, 29010 Málaga, Spain
- Surgery Department, University of Sevilla, 41009 Seville, Spain
| | - Mariantonia Ferrara
- Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WL, UK
- School of Medicine, University of Málaga, 29016 Málaga, Spain
| | - Assad Jalil
- Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WL, UK
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Cristescu IE, Ivanova T, Moussa G, Ferrara M, Patton N, Dhawahir-Scala F, Ch’ng SW, Mitra A, Tyagi AK, Lett KS, Jalil A. Functional and Anatomical Outcomes of Pars Plana Vitrectomy for Epiretinal Membrane in Patients with Uveitis. Diagnostics (Basel) 2022; 12:diagnostics12123044. [PMID: 36553051 PMCID: PMC9777241 DOI: 10.3390/diagnostics12123044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose-To evaluate the anatomical and functional outcomes of vitrectomy and epiretinal membrane (ERM) peeling in patients with uveitis. Secondarily, we evaluated the effect of internal limiting membrane (ILM) peeling on surgical outcomes, and of surgery on uveitis activity and, thus, therapeutic regime. Methods-Bicentre, retrospective, interventional case series of 29 eyes of 29 consecutive patients affected by uveitis and ERM, that had undergone pars plana vitrectomy with ERM peel between 2012 and 2020, with a minimum postoperative follow-up (FU) of six-months. Demographic data, best-corrected visual-acuity (BCVA), clinical findings, intraoperative and postoperative complications, and macular optical-coherence-tomography scans were reviewed. Results-The mean (standard deviation) duration of follow-up was 32 (22) months. At six-month FU, mean central-retinal-thickness (CRT) significantly improved (from 456 (99) to 353 (86) microns; p < 0.001), and mean BCVA improved from 0.73 (0.3) to 0.49 (0.36) logMAR (p < 0.001), with only one (3%) patient experiencing worsening of vision. The rate of concomitant cystoid macular edema decreased from 19 (66%) eyes at presentation to eight (28%) eyes at final-FU (p = 0.003). Comparing eyes in which ILM peeling was performed in addition to ERM peeling only, BCVA or CRT reduction were comparable. Only a minority of six (21%) eyes had a worsening in uveitis activity requiring additional medications, whereas most patients resumed the same treatment (52%) or received less treatment (28%) (p = 0.673). Conclusions-Vitrectomy with ERM peeling led to favourable anatomical and functional outcomes in patients with uveitis regardless of whether the ILM is peeled or not. As in most patients, no activation of the uveitis requiring additional medications was noted, we do not recommend changes in anti-inflammatory/immunosuppressive therapy postoperatively.
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Affiliation(s)
- Irina-Elena Cristescu
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Tsveta Ivanova
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - George Moussa
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
- Correspondence: ; Tel.: +161-276-1234
| | - Mariantonia Ferrara
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Niall Patton
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Felipe Dhawahir-Scala
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Soon Wai Ch’ng
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Arijit Mitra
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Ajai K. Tyagi
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Kim Son Lett
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Assad Jalil
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
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Norton JC, Soliman MK, Yang YC, Kurup S, Sallam AB. Visual outcomes of primary versus secondary epiretinal membrane following vitrectomy and cataract surgery. Graefes Arch Clin Exp Ophthalmol 2021; 260:817-825. [PMID: 34625846 DOI: 10.1007/s00417-021-05425-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/30/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare visual outcomes, incidence of cystoid macular edema (CME), and rate of repeat epiretinal membrane (ERM) surgery following phacovitrectomy for primary and secondary ERM. METHODS Retrospective review of 178,856 cataract surgeries from 2003 to 2015. Eyes that underwent cataract surgery combined with ERM peel were included (n = 708). Eyes were divided into primary (n = 538) and secondary (n = 170) ERM groups. Patient demographics, visual acuity (VA), and postoperative CME were recorded. RESULTS Patients with secondary ERM had worse preoperative VA, 0.9 ± 0.6 logMAR (20/160 Snellen equivalent) as compared to patients with primary ERM, 0.6 ± 0.3 (20/80), respectively (p < 0.0001). There was no difference between the secondary and primary ERM groups in postoperative vision (0.5 ± 0.4 logMAR vs. 0.5 ± 0.3; p = 0.9962) or proportion with VA ≥ 20/40 (46.4% vs. 43.1%; p = 0.6744) at 12-24 weeks. Postoperative CME was twice as likely in the secondary ERM group (16.5%) compared to the primary ERM group (7.8%) (p = 0.0018). There was no difference in the rate of repeat ERM surgery between the secondary ERM group (1.8%) and the primary ERM group (1.5%) (p = 0.7308). CONCLUSION Eyes with secondary ERM had significant postoperative improvement in VA. They had worse preoperative VA and had a twofold increase in postoperative CME than primary ERM.
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Affiliation(s)
- J Corbin Norton
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Mohamed K Soliman
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Yit C Yang
- Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, New Cross, Wolverhampton, UK
| | - Shree Kurup
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
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Coassin M, Mori T, Mastrofilippo V, Sborgia G, De Maria M, Carlà MM, Di Zazzo A, Fontana L, Cimino L. Surgical management of post-uveitic epiretinal membranes. Eur J Ophthalmol 2021; 32:11206721211017750. [PMID: 34011201 DOI: 10.1177/11206721211017750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Previous reports described unfavorable visual outcomes after surgery for uveitic macular pucker. Our goal was to demonstrate that patients with history of uveitis may benefit from vitrectomy for epiretinal membrane if executed under appropriate circumstances. METHODS We performed pars plana vitrectomy with ERM and ILM peeling in patients with post-uveitic macular pucker who did not show signs of ocular inflammation for at least 3 months after the suspension of immunosuppressive therapy. Visual acuity, central macular thickness at OCT, ocular inflammation, and complications were recorded. RESULTS Twenty-six eyes were operated. Mean duration of follow-up was 67 months. Visual acuity significantly improved from 20/80 to 20/40 after surgery. Vision increased in 20 (77%), remained stable in 4 (15%), and decreased in 2 (8%) eyes. Best-corrected visual acuity ameliorated by at least 2 ETDRS lines in 14 eyes (54%). Contingency analysis did not show any statistical difference among the different types of uveitis (p = 0.46). Mean central foveal thickness improved postoperatively (428 ± 104 vs 328 ± 130 microns; p = 0.017). CONCLUSION Patients with uveitic epiretinal membrane benefit from vitrectomy with membranectomy if operated when intraocular inflammation had subsided.
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Affiliation(s)
- Marco Coassin
- Ophthalmology, University Campus Bio-Medico of Rome, Roma, Italy
| | - Tommaso Mori
- Ophthalmology, University Campus Bio-Medico of Rome, Roma, Italy
| | - Valentina Mastrofilippo
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Michele De Maria
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | | | - Antonio Di Zazzo
- Ophthalmology, University Campus Bio-Medico of Rome, Roma, Italy
| | - Luigi Fontana
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Traitement des uvéites intermédiaires, postérieures et panuvéites non infectieuses. J Fr Ophtalmol 2020; 43:341-361. [DOI: 10.1016/j.jfo.2019.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/02/2019] [Accepted: 03/28/2019] [Indexed: 01/01/2023]
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Raval V, Rao S, Das T. Anatomical and functional outcomes of pars plana vitrectomy for inflammatory epiretinal membrane surgery in healed toxoplasmosis infection. Indian J Ophthalmol 2018; 66:1485-1489. [PMID: 30249848 PMCID: PMC6173008 DOI: 10.4103/ijo.ijo_364_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Epiretinal membrane over macula secondary to toxoplasmosis compromises vision. We describe the outcome of pars plana vitrectomy and epiretinal membrane removal after adequate treatment of acute infection. The average age of all four male patients was 36 years (range 20–60 years). Following surgery there was an average three or more lines visual acuity improvement, restoration of foveal contour with reduction in central macular thickness. One patient developed choroidal neovascular membrane postsurgery and was effectively treated with intravitreal bevacizumab. Surgery for ERM secondary to healed toxoplasmosis infection has good anatomical outcome and reasonable visual improvement, when the surgery is done in a quiet eye.
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Affiliation(s)
- Vishal Raval
- Retina Vitreous Service, L V Prasad Eye Institute, KVC Campus, Tadigadapa, Vijayawada, Andhra Pradesh, India
| | - Srinivas Rao
- Retina Vitreous Service, L V Prasad Eye Institute, KVC Campus, Tadigadapa, Vijayawada, Andhra Pradesh, India
| | - Taraprasad Das
- Retina Vitreous Service, L V Prasad Eye Institute, KVC Campus, Tadigadapa, Vijayawada, Andhra Pradesh, India
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8
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Rao P, Todorich B, Yonekawa Y, Wang J, Sobrin L, Faia LJ. Surgical Outcomes of Epiretinal Membranes in Patients with a History of Well-Controlled Preoperative Uveitis. ACTA ACUST UNITED AC 2018; 2:192-196. [DOI: 10.1016/j.oret.2017.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 11/27/2022]
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Preoperative Inflammatory Control and Surgical Outcome of Vitrectomy in Intermediate Uveitis. J Ophthalmol 2017; 2017:5946240. [PMID: 28465834 PMCID: PMC5390648 DOI: 10.1155/2017/5946240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/27/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose. To demonstrate the long-term effectiveness of vitrectomy for intermediate uveitis (IU) and to determine whether complete control of inflammation before vitrectomy is necessary. Methods. This retrospective study included 66 eyes of 66 patients with IU who underwent vitrectomy for vitreoretinal complications. Eyes were followed for at least 12 months after vitrectomy. The degree of inflammation control and visual acuity were compared before and after vitrectomy. These parameters were compared according to the presence of complete inflammation control before surgery. Results. The indications of vitrectomy included epiretinal membrane (26 eyes), vitreous opacity (21 eyes), and tractional retinal detachment (12 eyes), among others. Uveitic attacks did not occur in 44 of the 66 patients after vitrectomy. The numbers of uveitis attacks, local steroid injections, and systemic medications significantly decreased, and vision meaningfully improved after vitrectomy. These parameters did not differ significantly, regardless of the presence of preoperative inflammation. Conclusions. This study showed that vitrectomy is a good modality to manage vitreoretinal complications associated with IU, even if complete control of intraocular inflammation is not achieved before vitrectomy.
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Abstract
PURPOSE To evaluate outcomes and complications of pars plana vitrectomy in patients with epiretinal membrane secondary to toxoplasmic retinochoroiditis. METHODS Retrospective evaluation of the records of 14 patients who underwent pars plana vitrectomy for epiretinal membrane secondary to toxoplasmic retinochoroiditis. The best-corrected visual acuity, intraoperative and postoperative complications, and macular optical coherence tomography were analysed. All patients received postoperative prophylactic treatment with trimethoprim/sulfamethoxazole. RESULTS Fourteen patients, 5 men and 9 women, were included. Mean follow-up period after surgery was 6.07 ± 2.64 months. Preoperative mean best-corrected visual acuity was 20/200, and postoperative mean best-corrected visual acuity was 20/60. There were no intraoperative complications. Three patients developed posterior capsule opacification, and one patient developed cataract. CONCLUSION Pars plana vitrectomy is a safe and effective procedure in patients with epiretinal membrane secondary to toxoplasmic retinochoroiditis, improving both visual acuity and anatomical result on macular optical coherence tomography. The most frequent postoperative complications were posterior capsule opacification and cataract. No recurrences of the disease were recorded.
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Branson SV, McClafferty BR, Kurup SK. Vitrectomy for Epiretinal Membranes and Macular Holes in Uveitis Patients. J Ocul Pharmacol Ther 2017; 33:298-303. [PMID: 28112568 DOI: 10.1089/jop.2016.0142] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Macular pathology, including macular holes (MHs), epiretinal membranes (ERMs), and macular edema, is a cause of irreversible vision loss in the setting of uveitis. Medical management involves corticosteroids, immunomodulatory medications, and biologics to control inflammation. Pars plana vitrectomy (PPV) has been suggested as a therapy for uveitis, with reports of reduced inflammation and decreased dependence on medication postoperatively. Currently, PPV is reserved for retinal detachments, vitreous opacities, and ERMs, causing vitreomacular traction. However, little is known about the visual outcomes of PPV with ERM peel for MH, or in ERM without evidence of traction in the context of uveitis. METHODS Review of small case series and case reports support both conservative medical treatment and vitrectomy, independently, and in combination, in the management of macular pathology in the setting of uveitis. RESULTS AND CONCLUSIONS Further studies are required to study uveitic etiologies separately with respect to visual outcomes after vitreoretinal surgery and medical management.
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Affiliation(s)
- Sara V Branson
- 1 Ophthalmology Department, Emory University School of Medicine , Atlanta, Georgia
| | - Brendan R McClafferty
- 2 Departments of Ophthalmology and Family Medicine, Wake Forest University , Winston-Salem, North Carolina
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Kempen JH, Gewaily DY, Newcomb CW, Liesegang TL, Kaçmaz RO, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Suhler EB, Thorne JE, Foster CS, Jabs DA, Payal A, Fitzgerald TD. Remission of Intermediate Uveitis: Incidence and Predictive Factors. Am J Ophthalmol 2016; 164:110-7.e2. [PMID: 26772874 DOI: 10.1016/j.ajo.2015.12.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 12/28/2015] [Accepted: 12/31/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the incidence of remission among patients with intermediate uveitis; to identify factors potentially predictive of remission. DESIGN Retrospective cohort study. METHODS Involved eyes of patients with primary noninfectious intermediate uveitis at 4 academic ocular inflammation subspecialty practices, followed sufficiently long to meet the remission outcome definition, were studied retrospectively by standardized chart review data. Remission of intermediate uveitis was defined as a lack of inflammatory activity at ≥2 visits spanning ≥90 days in the absence of any corticosteroid or immunosuppressant medications. Factors potentially predictive of intermediate uveitis remission were evaluated using survival analysis. RESULTS Among 849 eyes (of 510 patients) with intermediate uveitis followed over 1934 eye-years, the incidence of intermediate uveitis remission was 8.6/100 eye-years (95% confidence interval [CI], 7.4-10.1). Factors predictive of disease remission included prior pars plana vitrectomy (PPV) (hazard ratio [HR] [vs no PPV] = 2.39; 95% CI, 1.42-4.00), diagnosis of intermediate uveitis within the last year (HR [vs diagnosis >5 years ago] =3.82; 95% CI, 1.91-7.63), age ≥45 years (HR [vs age <45 years] = 1.79; 95% CI, 1.03-3.11), female sex (HR = 1.61; 95% CI, 1.04-2.49), and Hispanic race/ethnicity (HR [vs white race] = 2.81; 95% CI, 1.23-6.41). Presence/absence of a systemic inflammatory disease, laterality of uveitis, and smoking status were not associated with differential incidence. CONCLUSIONS Our results suggest that intermediate uveitis is a chronic disease with an overall low rate of remission. Recently diagnosed patients and older, female, and Hispanic patients were more likely to remit. With regard to management, pars plana vitrectomy was associated with increased probability of remission.
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Affiliation(s)
- John H Kempen
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Dina Y Gewaily
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Deglin and Greene Retinal Center, Wynnewood, Pennsylvania
| | - Craig W Newcomb
- Department of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Teresa L Liesegang
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - R Oktay Kaçmaz
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Allergan, Inc, Dublin, Ireland
| | - Grace A Levy-Clarke
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland; Tampa Bay Uveitis Center, Tampa, Florida
| | | | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Department of Medicine, Oregon Health & Science University, Portland, Oregon; Devers Eye Institute, Portland, Oregon
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Portland Veterans' Affairs Medical Center, Portland, Oregon
| | - Jennifer E Thorne
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Abhishek Payal
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Oregon Health & Science University, Portland, Oregon; Portland Veterans' Affairs Medical Center, Portland, Oregon
| | - Tonetta D Fitzgerald
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Surgical Management of Uveitis Patients. CURRENT SURGERY REPORTS 2015. [DOI: 10.1007/s40137-015-0121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE To report the outcomes of pars plana vitrectomy with epiretinal membrane (ERM) peel, with or without internal limiting membrane peel, in patients with uveitis. METHODS Retrospective interventional case series of patients undergoing pars plana vitrectomy with ERM peel between January 2005 and March 2012. Sixteen consecutive patients (16 eyes) were identified, with a minimum postoperative follow-up of 6 months. Visual acuity, anatomical outcomes, perioperative control of inflammation, and complications were assessed. RESULTS The mean age at surgery was 47.3 years (range, 14-68 years), with a mean duration of ERM at surgery of 21.3 months (3-84 months). At 6 months, visual acuity improved in 31.25% of eyes, stabilized in 31.25%, and was worse in 37.5%. The causes of reduced visual acuity postoperatively included severe preexisting macular pathology and unoperated cataract. CONCLUSION Pars plana vitrectomy with ERM peel in eyes with uveitis may improve or stabilize visual acuity, especially in eyes with macular traction, but in the absence of traction, outcomes are variable and unpredictable. Prevention of ERM formation by aggressive control of inflammation is important.
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16
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Surgical results of idiopathic and secondary epiretinal membrane. Int Ophthalmol 2014; 34:1227-32. [PMID: 25331229 DOI: 10.1007/s10792-014-0010-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
The aim of the study is to compare the surgical results of patients with an idiopathic and secondary epiretinal membrane (ERM) after pars plana vitrectomy and membranectomy. The medical records of 51 consecutive patients with ERM who underwent pars plana vitrectomy and membranectomy with a follow-up >1 year were reviewed retrospectively. Age, sex, best-corrected visual acuity (BCVA, logMAR), lens status, presence of additional removal of internal limiting membrane (ILM), and recurrence rate within 1 year after the operation were compared in the idiopathic and secondary ERM groups. Forty-one eyes had idiopathic ERM and 10 eyes had secondary ERM. Preoperative average BCVA values in the two groups were 0.47 and 0.70, respectively, and the postoperative average BCVA values were 0.28 and 0.18, respectively, with significant improvement postoperatively in both groups (p < 0.01, p < 0.01). The recurrence rate within 1 year after surgery in the idiopathic group was 4.88 % and that in the secondary group was 20 % (p = 0.03). The recurrence rate was 4.3 % in the idiopathic group with ILM removal and it was 5.9 % without ILM removal (p = 0.03). No case recurred within 1 year in the secondary group with ILM removal but the recurrence rate was 33.3 % in the group without ILM removal (p = 0.01). Although patients with secondary ERM gained better visual acuity improvement postoperatively, the recurrence rate was higher within 1 year than that of patients with idiopathic ERM. Removal of the ILM may lower recurrence rates.
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Quellec G, Charrière K, Lamard M, Droueche Z, Roux C, Cochener B, Cazuguel G. Real-time recognition of surgical tasks in eye surgery videos. Med Image Anal 2014; 18:579-90. [DOI: 10.1016/j.media.2014.02.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/07/2014] [Accepted: 02/17/2014] [Indexed: 01/23/2023]
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Salcedo-Villanueva G, Arellanes-García L, Fromow-Guerra J, Hernández-Quintela E. [Association of epiretinal membranes with macular edema in pars planitis]. ACTA ACUST UNITED AC 2013; 89:22-6. [PMID: 24332688 DOI: 10.1016/j.oftal.2013.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 07/26/2013] [Accepted: 09/17/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Pars planitis (PP) is a form of intermediate uveitis that manifests with several posterior segment complications, including cystoid macular edema (CME) and epiretinal membrane formation (ERM). On the presence of CME the patient is usually treated with anti-inflammatory and/or immunosuppressive drugs. However the presence of CME may coexist with ERM formation, and therefore the treatment could be different. PURPOSE To determine the association between ERM and CME in PP. MATERIALS AND METHODS Case control series. The charts of patients diagnosed with PP were retrospectively reviewed. All patients had fluorescein angiogram (FA) and spectral domain optical coherence tomography (SD-OCT). Presence of ERM was determined by SD-OCT, while CME was determined by FA. Contingency tables were used to determine the risk of developing CME with ERM. RESULTS 31 eyes presented ERM. 16 eyes presented CME. Relative risk to have CME and ERM was 0.971, with a P value of 0.77 (χ(2)). CONCLUSIONS There is no association between ERM formation and the development of CME. There is no evidence to suggest a surgical approach as first line of treatment with the presence of ERM in PP.
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Affiliation(s)
- G Salcedo-Villanueva
- Asociación Para Evitar la Ceguera (APEC), Hospital Dr. Luis Sánchez Bulnes, Institución de Asistencia Privada, Servicio de Retina, Coyoacán, México.
| | - L Arellanes-García
- Asociación Para Evitar la Ceguera (APEC), Hospital Dr. Luis Sánchez Bulnes, Institución de Asistencia Privada, Servicio de Retina, Coyoacán, México
| | - J Fromow-Guerra
- Asociación Para Evitar la Ceguera (APEC), Hospital Dr. Luis Sánchez Bulnes, Institución de Asistencia Privada, Servicio de Retina, Coyoacán, México
| | - E Hernández-Quintela
- Asociación Para Evitar la Ceguera (APEC), Hospital Dr. Luis Sánchez Bulnes, Institución de Asistencia Privada, Servicio de Retina, Coyoacán, México
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Abstract
The purpose of this article is to highlight evidence about the medical and surgical management of intermediate uveitis (IU). Updated understandings of the immunopathology of IU were reviewed in this retrospective literature review. Literature selection for this review was based on the PubMed database (National Library of Medicine) and OVID database (Wolters Kluwer). Articles deemed relevant were selected and highlighted. Intermediate uveitis is most often a benign form of uveitis. Since intermediate uveitis has been described in association with different systemic disorders, the initial diagnostic evaluation should serve to exclude masquerade syndromes and infectious diseases in which immunosuppression may be ineffective or contraindicated. Although the pathogenesis of intermediate uveitis is not fully understood, identification of proinflammatory molecules involved in the IU has contributed to the development and implementation of new therapies. Studies about the use of various immunosuppressants, biological agents and surgical treatment on IU have provided more evidence for managing IU. Nevertheless, corticosteroids remain the mainstay of treatment. The treatment options of intermediate uveitis are evolving, with the development of various immunosuppressants and biological agents. The management of intermediate uveitis should be tailored individually, based on specific causes of the disease and associated complications.
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Affiliation(s)
- Frank H P Lai
- From the Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China
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Figueroa M, Noval S, Contreras I, Arruabarrena C, García-Pérez J, Sales M, Gil-Cazorla R. La vitrectomía como terapia antinflamatoria de la uveítis intermedia en niños. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2010; 85:390-4. [PMID: 21354506 DOI: 10.1016/j.oftal.2010.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 08/16/2010] [Accepted: 10/05/2010] [Indexed: 10/26/2022]
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Molina-Prat N, Adán AM, Mesquida M, Pelegrini L, Rey A, Alvarez G. [Vitrectomy surgery for the treatment of the vitreo-retinal complications of the pars planitis]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2010; 85:333-336. [PMID: 21168058 DOI: 10.1016/j.oftal.2010.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 06/18/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the effect of pars plana vitrectomy in the management of patients with pars planitis. METHODS A retrospective analysis of the clinical course, post-operative complications and recurrent uveal inflammation following pars plana vitrectomy in patients with pars planitis. RESULTS The study included 22 eyes of 19 patients. The mean follow-up was 55.7 (± 39.6) months (range 7 - 144 months). The surgical indications were, persistent vitreous opacities in 10 eyes, vitreous haemorrhage in 9 eyes, and epiretinal membrane in 3 eyes. There was an improvement in the clinical course of the uveitis in 19 of the 22 eyes (86.4%), allowing the suspension of the systemic treatment in 16 patients. An improvement of the visual acuity was observed in 20 eyes (90.9%). The most common post-operative complications were, lens opacities in 9 eyes (40.9%), and glaucoma in 4 eyes (18.2%). CONCLUSIONS The results of this study suggest that pars plana vitrectomy has a beneficial effect on the course and visual function of patients with vitreo-retinal complications associated with pars planitis.
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Affiliation(s)
- N Molina-Prat
- Instituto Clinic de Oftalmología, Hospital Clinic i Provincial de Barcelona, Barcelona, España.
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Quinones K, Choi JY, Yilmaz T, Kafkala C, Letko E, Foster CS. Pars Plana Vitrectomy versus Immunomodulatory Therapy for Intermediate Uveitis: A Prospective, Randomized Pilot Study. Ocul Immunol Inflamm 2010; 18:411-7. [DOI: 10.3109/09273948.2010.501132] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ieki Y, Kiryu J, Kita M, Tanabe T, Tsujikawa A, Yamashiro K, Miyamoto N, Miura S, Honda Y. Pars plana vitrectomy for vitreous opacity associated with ocular sarcoidosis resistant to medical treatment. Ocul Immunol Inflamm 2009; 12:35-43. [PMID: 15209462 DOI: 10.1076/ocii.12.1.35.28070] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the results of pars plana vitrectomy for nonclearing vitreous opacities associated with ocular sarcoidosis that is resistant to corticosteroid treatment. METHODS Eight consecutive patients (11 eyes) with vitreous opacities and uveitis associated with sarcoidosis were studied. All patients were resistant to or intolerant of corticosteroid therapy. All eyes underwent pars plana vitrectomy, followed by evaluation of visual acuity and recording of the grade of inflammation and complications. RESULTS Seven eyes had gained two or more lines of Snellen visual acuity six months postoperatively; visual acuity remained unchanged in the other four eyes. Vitreous inflammation was reduced in all cases. Severe postoperative inflammation did not recur in any eyes. Five eyes developed visually significant cataracts and underwent cataract extraction and intraocular lens insertion within 8-30 months. Based on slit-lamp biomicroscopy and fluorescein angiography, preoperative cystoid macular edema in five eyes resolved or improved within six months after vitrectomy. Postoperative complications included elevated intraocular pressure in three eyes, cataract formation in six eyes, epiretinal membrane formation in one eye, and choroidal neovascularization in one eye. None of the patients developed cystoid macular edema postoperatively. Only three patients received systemic corticosteroids after surgery. At the final visit, only one patient required systemic corticosteroid therapy. CONCLUSIONS Pars plana vitrectomy appears to have beneficial effects on restoring vision, stabilizing vitreous inflammation, and reducing systemic corticosteroid requirements in eyes with thick vitreous opacities associated with sarcoidosis that is resistant to medical treatment.
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Affiliation(s)
- Yoshiaki Ieki
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Pars planitis: a 20-year study of incidence, clinical features, and outcomes. Am J Ophthalmol 2007; 144:812-817. [PMID: 18036872 DOI: 10.1016/j.ajo.2007.08.023] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 08/05/2007] [Accepted: 08/10/2007] [Indexed: 11/22/2022]
Abstract
PURPOSE To measure the incidence of pars planitis in a community-based population and to report clinical features, complications, and visual prognosis. DESIGN Population-based, retrospective, 20-year cohort study. METHODS Multicenter study using the Rochester Epidemiology Project medical records linkage system, which allows analysis of almost all patients within Olmsted County, Minnesota, with a given medical condition. Databases were searched to identify all patients with pars planitis from January 1, 1985 through December 31, 2004. Forty-six eyes of 25 patients were evaluated. RESULTS Mean follow-up was 14.3 years. The incidence of pars planitis was 2.077 per 100,000 persons (95% confidence interval [CI], 1.43 to 2.62). The most common complications were epiretinal membrane (ERM) in 17 eyes (36%), cataract in 14 eyes (30.4%), and cystoid macular edema (CME) in 12 eyes (26.1%). Mean visual acuity after 10 years of follow-up was 20/30, with 18 of 24 patients maintaining a visual acuity of 20/40 or better. One-third of patients maintained normal visual acuity without requiring treatment. CONCLUSIONS The visual prognosis of pars planitis is relatively good, with 75% of patients maintaining a visual acuity of 20/40 or better after 10 years. Many patients with mild disease do not require treatment. A subset of patients, however, experience severe disease with severe vision loss despite treatment. The rate of smoking and multiple sclerosis in patients with pars planitis is much higher than that of the general population.
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Trittibach P, Koerner F, Sarra GM, Garweg JG. Vitrectomy for juvenile uveitis: prognostic factors for the long-term functional outcome. Eye (Lond) 2006; 20:184-90. [PMID: 15803175 DOI: 10.1038/sj.eye.6701845] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study evaluated the long-term effect of pars plana vitrectomy (PPV) in children and adolescents with chronic uveitis on visual function, anatomical outcome, and the requirement of systemic treatment. Further, predictive preoperative factors associated with a beneficial visual outcome were assessed. METHODS Retrospective review of 29 eyes of 23 consecutive paediatric and juvenile patients below 20 years of age with chronic uveitis who underwent a PPV for visually significant opacities in 25 eyes, vitreous haemorrhage in three eyes, and retinal detachment in one eye. The clinical diagnosis was chronic intermediate uveitis in 22 eyes and retinal vasculitis of different origin in seven eyes. RESULTS LogMAR visual acuity improved from an average of 0.91 to 0.33 (P<0.001). Cystoid macular oedema (CME) was significantly reduced in eight of 10 eyes postoperatively (P=0.021). In the multiple regression analysis, a low preoperative logMAR visual acuity and the presence of a CME had a negative influence on the final logMAR visual acuity. Furthermore, the appearance of chronic uveitis relapses was significantly reduced from 15 eyes before to seven eyes after surgery (P=0.042). CONCLUSIONS PPV has a beneficial effect on the course and the complications of chronic uveitis in paediatric and juvenile patients with respect to the anatomical and visual outcome. Preoperative logMAR visual acuity and clinically significant CME were the most accurate predictors for the functional outcome.
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Affiliation(s)
- P Trittibach
- Division for Vitreoretinal Diseases, Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland
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Dugel PU, Kunimoto DY, Smith RE. Pars Planitis. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50101-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Meier P, Wiedemann P. Surgical Aspects of Vitreoretinal Disease in Children. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Becker M, Davis J. Vitrectomy in the treatment of uveitis. Am J Ophthalmol 2005; 140:1096-105. [PMID: 16376658 DOI: 10.1016/j.ajo.2005.07.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Revised: 07/01/2005] [Accepted: 07/02/2005] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess the evidence that pars plana vitrectomy (PPV) is useful in improving vision, reducing disease activity, or ameliorating cystoid macular edema (CME) in patients with uveitis. DESIGN Review of the literature. METHODS A Medline search was conducted for relevant articles published in English, German, or French. Articles were analyzed for content and evidence level. RESULTS A total of 44 interventional case series published between 1981 and 2005 were identified that included 1575 patients (1762 eyes). Evidence level was grade CII-3 indicating possibly improved clinical outcomes with fair or poor evidence. The average age of patients was 36 years with a median duration of uveitis before surgery of 48 months and a median follow-up of 1.9 years. Intermediate uveitis was present in 841 eyes. Cystoid macular edema and cataract were common co-morbidities, and there were large numbers of additional surgical procedures. Visual outcomes in 39 articles were stated as improved in 708 eyes (68%), unchanged in 202 eyes (20%), and worsened in 124 eyes (12%). Reduction in systemic medication following PPV was reported in 25 studies. The median reported percentage of patients per study with CME was 36% preoperatively and 18% postoperatively. CONCLUSIONS Based on the evidence in the literature, PPV is possibly relevant to the outcomes of improving vision and reducing inflammation and CME. Randomized, controlled, collaborative trials or hypothesis-based case series with precise outcome measures that incorporate control groups would improve the quality of evidence supporting PPV as an adjunct to the medical treatment of uveitis.
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Affiliation(s)
- Matthias Becker
- Bascom Palmer Eye Institute, University of Miami School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA
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Scott RA, Haynes RJ, Orr GM, Cooling RJ, Pavésio CE, Charteris DG. Vitreous surgery in the management of chronic endogenous posterior uveitis. Eye (Lond) 2003; 17:221-7. [PMID: 12640410 DOI: 10.1038/sj.eye.6700299] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES There is evidence that pars plana vitrectomy (PPV) has a beneficial effect on the clinical course of chronic endogenous posterior uveitis (EPU) possibly by physically removing any resident inflammatory cells with the vitreous. We assessed the anatomical and therapeutic effects of PPV performed on patients with chronic EPU for any indication. PATIENTS AND METHODS Retrospective review of 41 eyes of 38 consecutive patients with EPU who underwent a PPV for any reason, over a 5-year period. The mean age of the patients was 36.2 years, 46% of the eyes had intermediate uveitis, 32% panuveitis, and 22% posterior uveitis. The visual acuity, disease activity, and the requirement for medications to control it were recorded for 12 months pre- and postoperatively. RESULTS Overall, 61% of the eyes gained more than 2 Snellen lines (P<0.001) and the incidence of cystoid macular oedema (CMO) significantly reduced from 44 to 20% (P<0.05). Postoperatively, there was a significant decrease in the recurrence rate of intermediate uveitis, posterior uveitis, and panuveitis (P<0.001). The use of systemic and local depot immunosuppressive agents did not change over the study period, although the use of topical agents increased (P<0.05). CONCLUSION PPV appears to have a beneficial effect on the clinical course of EPU in selected cases. This may be mediated by the physical clearance of inflammatory debris, the anti-inflammatory effect of replacing vitreous by aqueous humour, by a reduction of CMO and/or the anatomical correction of sight-threatening retinal pathology.
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Yamamoto T, Hitani K, Tsukahara I, Yamamoto S, Kawasaki R, Yamashita H, Takeuchi S. Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema. Am J Ophthalmol 2003; 135:14-9. [PMID: 12504691 DOI: 10.1016/s0002-9394(02)01819-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the early postoperative changes in retinal thickness and complications after pars plana vitrectomy for diabetic macular edema. DESIGN Consecutive interventional case series. METHODS Studied retrospectively, pars plana vitrectomy was performed on 65 consecutive eyes of 63 patients with diabetic macular edema. The follow-up interval ranged from 6 to 36 months (12.6 +/- 7.4 months [mean +/- standard deviation (SD)]). The indications of pars plana vitrectomy in this study were (1) diffuse diabetic macular edema, (2) preoperative visual acuity less than 20/40, and (3) noneffective macular photocoagulation therapy. Preoperative and postoperative examinations by stereoscopic biomicroscopy, color fundus photography of the macula and optical coherence tomography (OCT) were performed on all eyes. Preoperatively, direct photocoagulation to microaneurysms in the macula had been performed in 48 eyes, and focal/grid photocoagulation had been performed in five eyes. Preoperative examination showed that epiretinal membranes were observed in 20 eyes, cystoid macular edema in 40 eyes, and 23 eyes had a complete posterior vitreous detachment (PVD). Epimacular membranes, removed during surgery, were examined histopathologically. RESULTS The postoperative mean best-corrected visual acuity (logarithm of the minimum angle of resolution [logMAR] = 0.696 +/- 0.491 [mean +/- SD]) was significantly better than the preoperative mean best-corrected visual acuity (0.827 +/- 0.361; P <.0001; Wilcoxon signed-rank test). The final visual acuity improved by 2 or more lines in 32 of 65 eyes (45%), remained unchanged in 32 of 65 eyes (49%), and exacerbated after the surgery in 4 of 65 eyes (6%) due to neovascular glaucoma (2 eyes) and residual cystoid macular edema (2 eyes). The postoperative foveal retinal thickness (224.9 +/- 116.9 microm) at the last visit was significantly thinner than the preoperative foveal retinal thickness (463.7 +/- 177.3 microm; P <.0001; Wilcoxon signed-rank test). The foveal retinal thickness did not decrease linearly but fluctuated: The mean postoperative retinal thickness had decreased significantly 7 days after surgery, then remained unchanged for approximately 1 month, and thereafter gradually decreased until 4 months. The intraoperative and postoperative complications included peripheral retinal tear in 3 of 65 (4.6%) eyes, postoperative rhegmatogenous retinal detachment in 1 of 65 (1.5%) eyes, neovascular glaucoma in 3 of 65 (5%) eyes, recurrent vitreous hemorrhage in 1 of 65 (1.5%) eyes, hard exudates in the center of the macula in 3 of 56 (4.6%) eyes, postoperative epiretinal membrane formation in 9 of 65 (13.8%) eyes, and a lamellar macular hole in 1 of 65 (1.5%) eyes. CONCLUSIONS Vitrectomy for diabetic macular edema is an effective procedure for reducing the edema and improving visual acuity. Because the postoperative reduction in retinal thickness is not complete until 4 months, the assessment of vitrectomy on foveal thickness should not be made until this time. In addition, there are severe complications from vitrectomy for diabetic macular edema, and careful preoperative and postoperative examinations and surgical methods are required.
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Affiliation(s)
- Teiko Yamamoto
- Department of Ophthalmology, Toho University Sakura Hospital, Chiba, Japan.
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McDonald HR. Diagnostic and therapeutic challenges. Retina 2002; 22:633-6. [PMID: 12441730 DOI: 10.1097/00006982-200210000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- H Richard McDonald
- The Wilmer Ophthalmological Institute, and The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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McDonald HR. Diagnostic and therapeutic challenges. Retina 2002; 22:208-12. [PMID: 11927855 DOI: 10.1097/00006982-200204000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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