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Atsushi Tanaka, Kei Takayama, Tadashi Muraoka, Sho Ishikawa, Kohzou Harimoto, Masaru Takeuchi; Surgical Outcome of Minimal Incision Vitrectomy System for Ocular Complications in Patients with Granulomatous Uveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2321.
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The primal treatment of granulomatous uveitis is to reduce ocular inflammation by medical techniques. However, in the case that chronic and recurrent inflammation gives rise to irreversible complications that are refractory to medical treatment, surgical treatment is performed to maintain or improve the patient's visual function. In this study, we indicate outcome of 23g or 25g minimal incision vitrectomy system (MIVS) performed for ocular complications in patients with granulomatous uveitis.
Vitreous surgery was performed for 19 patients 24 eyes (Male 6 patients 9 eyes, Female 13 patients 15 eyes) with complications in the posterior segment of the eye resistant for medical treatment of granulomatous uveitis including sarcoidosis attending the uveitis clinic at National Defense Medical college between April 2010 and November 2013.The average age was 66.3 +/- 9.3 years (ranging from 44 to 79 years). Sarcoidosis was 10 patients 14 eyes, and granulomatous uveitis who fulfilled the diagnostic criteria of ocular sarcoidosis but not fulfilled the diagnostic criteria of systemic sarcoidosis was 9 patients 10 eyes. The complications treated by vitreous surgery were vitreous opacity, 21 eyes; vitreous hemorrhage, 1 eye; epiretinal membrane, 9 eyes; retinal detachment, 3 eyes; macula hole, 1 eye; cystoid macular edema, 9 eyes (including overlaps). All patients were operated in clinically inactive inflammation phase in all eyes, and operated for cataract in 17 eyes at the same time. The average follow period was 15 months (ranging from 0 to 40months).
Visual acuity was improved in 16 out of 24 eyes after operation, in which sarcoidosis-associated uveitis was 11 of 14 eyes (78.5%) and the other granulomatous uveitis was 5 of 10 eyes (50.0%). However visual acuity was aggravated in 1 eye of sarcoidosis-associated uveitis and 3 eyes of the other granulomatous uveitis. The complications after vitreous surgery were vitreous hemorrhage in 2 eye and glaucoma in 4 eyes of only eyes with sarcoidosis.
Vitrectomy was generally effective for medically refractory ocular complications of granulomatous uveitis including sarcoidosis, with favorable outcomes of improved visual acuity. However, the efficacy would be sometimes not expected in subclinically inflamed eyes with sarcoidosis.
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