First Author: S.Subramani UK
Co Author(s): D. Park N. Jones A. Jalil
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This retrospective study aimed to report visual acuity (VA) change, macular status, and control of intraocular inflammation in patients who underwent pars plana vitrectomy for uveitis related indications. The results are intended to guide uveitis and vitreoretinal specialists contemplating surgery in similar cases.
The study was done at the Manchester Royal Eye Hospital (UK) – a tertiary referral centre for uveitis and vitreoretinal surgery.
Uveitic patients who underwent vitrectomy surgery between March 2009 and May 2015 were identified from the vitreoretinal surgical database. Medical records and optical coherence tomography (OCT) data were retrospectively analysed. Uveitic patients undergoing vitrectomy surgery primarily for epiretinal membrane (ERM) peeling, retinal detachment, and patients in whom bacterial endophthalmitis was strongly suspected prior to the vitrectomy were excluded. The study was a retrospective observational study of 12 months of follow-up following vitrectomy. Data was analysed at 6 months (±1 month), and 12 months (± 2 months) from the date of vitrectomy.
The starting visual acuity was between LogMAR 0.26 and 2.28 (N=42, Mean=1.05, Median=0.80, StDev=0.7). At 6 months, 24/42(57%) improved, 7/42(17%) worsened, 4/42(10%) were unchanged, and data on 7/42(17%) patients were not available (Mean=0.58, Med=0.3, StDev=0.7, p<0.01). At 12 months 27/42(64%) improved, 5/42 (12%) worsened, 2/42(5%) were unchanged, and data on 8/42 (19%) patients were unavailable (Mean=0.46, Med=0.3, StDev=0.48, p<0.01). All 42 eyes had posterior segment inflammation at baseline of which 31 had concurrent anterior segment inflammation, and 3 had concurrent vitreous haemorrhage. At 12 months 18/42(43%) had no inflammation, 10/42(24%) only had anterior chamber inflammation, 5/42(12%) had combined anterior and posterior segment inflammation, 1/42(2%) had only posterior segment inflammation, and information on the remaining 8/42(19%) eyes was unavailable. At 12 months, 20/42(48%) of patients were on less treatment, 6/42(14%) had no change to treatment, 6/42(14%) who were on no treatment immediately prior to surgery were on topical steroids. Information on 8/42(19%) were unavailable. At 12 months, macula oedema resolved in 6/8 (75%) of eyes as well as 1 with post operative macular oedema. 1 eye had persistent macula oedema, and 1 patient did not attend.
There is a statistically significant improvement in visual acuity at 6 and 12 months following vitrectomy or combined phacovitrectomy for uveitis related indications. There was also an overall improvement in macular oedema status. This was irrespective of the starting visual acuity or primary reason for surgery. This is in conjunction with simultaneous appropriate control of the intraocular inflammation, although there was also a reduction in treatment needed to control intraocular inflammation.