Vitrectomy in the management of uveitis

OBJECTIVE: To review the indications for vitrectomy in uveitis cases. PATIENTS AND METHODS: Charts of patients seen at the uveitis clinic of the Jules Gonin Eye Hospital from January 1993 to August 1998 and who had undergone vitrectomy were reviewed. Patients with infectious uveitis occurring within three months after intraocular cataract surgery were excluded. The types of uveitis were recorded and indications for vitrectomy were analyzed. RESULTS: A total of 630 patients were examined at the uveitis clinic. Fifty-one of these patients (51 eyes, 8.1%) were referred for vitrectomy and were included in this study. Vitrectomy was performed for three reasons: 1) to treat the complications of uveitis (90%), including vitreous opacification in 35 eyes (69%), retinal detachment in seven eyes (14%), epimacular membrane in seven eyes (14%), and dense opacification of the posterior capsule after cataract surgery in six eyes (12%)(the mean delay between uveitis and vitrectomy in this group was 8.4 years); 2) for diagnostic purposes in 19 eyes (37%); and 3) to remove confined infectious foci in 16 eyes (31%) and allow a thorough intraocular distribution of antibiotics. Visual acuity improved in 41 patients (80.4%), remained unchanged in three (5.8%), and decreased in seven (13.7%) because of secondary or persistent retinal detachment or cystoid macular edema. CONCLUSION: Vitrectomy was indicated to treat the complications of uveitis, to provide vitreous for diagnostic purposes, and to allow a better diffusion of intraocular antibiotics. Long-standing uveitis did not seem to be influenced by vitrectomy.