In-Office and Bedside Sutureless Vitrectomy for the Diagnosis of Uveitis

Abstract

Purpose: : To show that we were easily,quickly,and efficiently able to use a portable,battery operated,sutureless 23 gauge portable vitrectomy system for the diagnosis of unknown acute or chronic uveitis.All vitreous biopsy cases were done in the office or at the bedside.In 10 - 20 % of cases there exists a need for a diagnostic vitrectomy if other testing has failed to reveal the cause. In the past, all patients were usually bought to the operating room for this procedure.Our results for vitreous biopsies were similar or better than similar diagnostic vitrectomies done in the operating room.

Methods: : This study was performed in accordance with the Declaration of Helsinki.Obvious cases of infections were excluded. 21 unknown cases of either unilateral or bilateral uveitis patients were retrospectively studied whom had prior negative workups.Ages ranged from 12-75 years.All patients underwent an office or bedside sutureless operated vitrectomy with the INTRECTOR^R.It is self sealing, portable and can easily and quickly obtain vitreous (up to 1 cc) for diagnostic sampling.Local subconjunctival anesthesia was used. Specimens were sent for multiple studies as needed.Diagnostic results were matched to historical past series.The average specimen was 0.7cc.Results; Positive findings were noted in 11/ 21 patients yielding 52.4 %. Cytology was positive for leukemia and lymphoma on 2 patients. Herpes or CMV virus came back on PCR testing in 6 patients. Nocardia and amyloidosis came back on staining and culture in 2 patients.Historical diagnostic yields have typically ranged from 10 -61 % of cases, depending on suspected causes.J Davis reported the highest diagnostic yield of 61.5 % in her case series.Of note , that study included suspected infections..

Conclusions: : Our excellent results of a 52.4 % yield are consistent with and better then most prior studies.We included no suspected infections. Minimal equipment is needed.We have shown that the INTRECTOR^R vitreous biopsy can easily be done at both the bedside and in the office. This one step, 23 gauge, self sealing,sutureless , hand held, portable, battery operated transconjunctival vitrector has been available since 1994.The present manufacturer is Insight Instruments(Stuart, Fla).While being 23 gauge , the opening of the scleral wound and the incision size (0.69 mm) is actually the same size as a 25 gauge system which uses trocars.This system does not use trocars.and is a true 23 gauge opening.Costs,along with time are minimal.While being used in the office or at the bedside in this series,it can also be as easily used efficiently in the operating room..Both quicker diagnosis and treatment in selected vitreous biopsies can now be safely made using this portable vitrectomy system.

Keywords: vitreoretinal surgery • chorioretinitis • vitreous