Predictive factors for post-operative complications in diagnostic vitrectomy

Abstract

 

Purpose

 

To determine predictive factors for post-operative complications in posterior uveitic eyes undergoing diagnostic vitrectomy.

 

Methods

 

Data were retrospectively collected over a period of 10 years (2001 to 2011) from theatre records. Multivariate logistic regression analysis was used to test for associations between clinical factors such as age, working diagnosis, type of surgery, site of inflammation, presence of posterior vitreous detachment (PVD) and visually-significant post-operative complications, including hypotony, suprachoroidal haemorrhage, retinal detachment and glaucoma requiring further surgical intervention.

 

Results

 

Ninety eight eyes from 96 patients who underwent diagnostic vitrectomy (DV) for posterior uveitis were identified. The mean age of the patients was 64.8 years (SD: 19.3) and the mean follow-up was 18 months (SD: 19.2). 32/98 eyes (32.7%) underwent DV alone, and 66/98 (67.3%) required additional procedure(s). 95 eyes (96.9%) had active vitritis, 23 (24.2%) retinitis, 10 (10.2%) vasculitis, and 12 (12.2%) papillitis. A working diagnosis of infectious panuveitis was made in 55 eyes (56.1%), inflammation in 13 (13.3%) and lymphocytic or leukemic infiltration in 30 (30.6%). Visual acuity (VA) was significantly worse both pre-, and post-operatively, in patients with visually significant post-operative complications (Figure 1). A pre-operative Snellen VA of 6/24 (20/80) or worse, was independently associated with visually significant post-operative complications (OR=3.35, 95% CI=1.58 to 9.5, p=0.01). The absence of PVD was not associated with worse VA at the final post-operative visit (p=0.13). A working diagnosis of infection or inflammation was associated with a good final VA (p=0.03) (Figure 2).

 

Conclusions

 

A baseline Snellen VA of less than 6/24 (20/80) is predictive of visually significant, post-operative complications after diagnostic vitrectomy. Patients with a working diagnosis of infection or inflammation have a better final visual prognosis compared to malignancy. The absence of a PVD does not have long-term prognostic significance on VA.

 

 

 

Keywords: 762 vitreoretinal surgery • 745 uvea