Presented in part at the International Uveitis Study Group (IUSG) Meeting, 9–12 September 2008, Lake Constance.
Letter to the Editor
Safety and efficacy of small incision, sutureless pars plana vitrectomy for patients with posterior segment complications secondary to uveitis
Version of Record online: 21 DEC 2011
Copyright © 2012 Acta Ophthalmologica Scandinavica Foundation
Volume 90, Issue 5, pages e409–e410, August 2012
How to Cite
Androudi, S., Praidou, A., Symeonidis, C., Tsironi, E., Iaccheri, B., Fiore, T., Tsinopoulos, I. and Brazitikos, P. (2012), Safety and efficacy of small incision, sutureless pars plana vitrectomy for patients with posterior segment complications secondary to uveitis. Acta Ophthalmologica, 90: e409–e410. doi: 10.1111/j.1755-3768.2011.02258.x
- Issue online: 27 JUL 2012
- Version of Record online: 21 DEC 2011
Pars plana vitrectomy (PPV) has been a natural accompaniment to pharmacotherapy in the treatment of ocular inflammatory diseases as it offers a surgical means to clear vitreous opacities and repair structural complications (Becker & Davis 2005). Recently, the evolution of sutureless 25-G vitrectomy system has led to minimization of the surgically induced trauma from peritomy and sclerotomy sites.
Apart from a single article reporting on combined sutureless PPV and phacoemulsification in uveitic eyes with cataract and posterior segment pathology (Soheilian et al. 2008), a systematic evaluation of the peer-reviewed literature recovered no studies or case series reporting the outcome of sutureless 25-gauge PPV in uveitic eyes.
Fifteen cases (14 patients) underwent 25-gauge PPV as a therapeutic procedure at the Department of Ophthalmology, Aristotle University of Thessaloniki, Greece. The mean patient age was 40 ± 19.7 (median: 32, range: 10–65 years). The mean duration of uveitis prior to surgery was 39.2 ± 44.5 (range: 1–168 months). The mean follow-up time was 17.2 ± 11.4 (range: 2–38 months). (All values above are expressed as mean ± SD). Institutional review board (IRB) approval was obtained for this study.
Table 1 summarizes the uveitis diagnosis, the pre and postoperative visual acuity (VA) values and postoperative complications for our study population.
|Disease||Indication||Mean duration of uveitis (months)||Pre-operative BCVA||Postoperative BCVA||Complications|
|1||Behçet’s||Vitreous heme||28||HM||20/100||None; macular ischemia|
|3||Toxoplasmosis||r/o endophthalmitis||96||CF||20/40||None; pt received antitoxoplasmic drugs postoperative|
|4||ARN||Retinal detachment||2||20/200||20/100||Cataract progression; extraction with sil-oil removal|
|5||Sarcoidosis||BRVO + Vitreous heme||38||20/200||20/80||Cataract progression|
|6||Behçet’s||Vitreous heme||18||CF||20/80||Cataract progression|
|7||Toxoplasmosis||ERM||27||20/80||20/25||None; mild macular oedema|
|8||MS||Vitreous heme||41||CF||20/30||Cataract progression|
|10||Behçet’s||Vitreous heme||14||CF||20/80||Cataract progression|
|12||Behçet’s||Retinal detachment||1||CF||20/25||None; pt started IMT postoperative|
|15||JIA||Vitreous heme||168||HM||20/100||Severe hypotony|
None of the eyes developed postoperative wound leakage, choroidal detachment or vitreous haemorrhage. Transient intraocular pressure (IOP) elevation postoperatively occurred in 7/15 patients (46.6%) and was normalized with medical treatment in all cases. One case (#15) with juvenile idiopathic arthritis uveitis (a single-eyed patient) showed extreme hypotony the first postoperative day, and we injected a mixture of 20% C3F8, without any improvement. We proceeded with triamcinolone acetonide injection, but still the hypotony persisted and recovered only after i.v. pulse methylprednisolone infusion, followed by tapering doses of oral steroids; we assume that the patient suffered from ciliary body shutdown that resulted in zero pressure readings, despite the absence of apparent surgical wound leakage.
One patient developed (#9) phthisis, secondary to a toxocara granuloma-related retinal detachment. This case was complicated primarily by severe proliferative vitreoretinopathy (PVR) and tractional retinal detachment with retinal breaks. Postoperatively, PVR continued to develop under silicone oil and despite the appropriate medical therapy.
Although sutureless 25-gauge PPV has been reported as a surgical approach for other forms of posterior segment involvement, there are some special considerations when it comes to uveitic cases.
Intraocular surgery may improve (Giuliari et al. 2010; Quinones et al. 2010) or exacerbate inflammation (Foster & Opremcak 2002) through activation of the underlying inflammatory process. Moreover, the procedure itself may result in an unusually severe inflammatory response, abnormal or excessive bleeding and/or unexpected postoperative intraocular pressure responses (hypertension or hypotony). It is clear that the most important factor contributing to a successful outcome is both pre and postoperative controls of the intraocular inflammation by topical, periocular and systemic steroids or immunosuppressive agents (Foster & Opremcak 2002).
Although the final role of vitrectomy in the management of patients with uveitis remains to be determined, our experience reveals that the 25 g surgical technique is a safe and efficacious approach in selected uveitis cases.
- 2005): Vitrectomy in the treatment of uveitis. Am J Ophthalmol 140: 1096–1105. & (
- 2002): Therapeutic surgery: cornea, iris, cataract, glaucoma, vitreous, retinal. In: Foster CS & Vitale A (eds). Diagnosis and treatment of uveitis. Philadelphia: WB Saunders, 222–235. & (
- 2010): Pars plana vitrectomy in the management of paediatric uveitis: the Massachusetts eye research and surgery institution experience. Eye 24: 7–13. , , et al. (
- 2010): Pars plana vitrectomy versus immunomodulatory therapy for intermediate uveitis: a prospective, randomized pilot study. Ocul Immunol Inflamm 18: 411–417. , , et al. (
- 2008): Sutureless combined 25-gauge vitrectomy, phacoemulsification, and posterior chamber intraocular lens implantation, for management of uveitic cataract associated with posterior segment disease. Retina 28: 941–946. , & (