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J. Potyka, M. Maier, K. Thuermel, I. Lanzl; The Value of Vitrectomy in Intraocular Inflammation and Uveitis in a General Hospital Setting. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5634.
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Vitrectomy in uveitis cases is mainly performed for three reasons: 1. evicting the causative organism when infectious origin is suspected, 2. identifying the underlying cause of the uveitis and 3. improving vision. The aim of our retrospective study was to evaluate the outcome of vitrectomy in uveitis cases from the general eye clinic of our university hospital.
Outcome after vitrectomy was retrospectively analyzed in 33 consecutive patient eyes requiring vitrectomy due to intraocular inflammation from 2005 till 2007. Vitrectomy specimen were analyzed by microbiological microscopy and cultures and histopathologic examination. If deemed necessary PCR and flow cytometry were performed.
Mean visual acuity improved significantly from 0,1 before surgery to 0,2 three months after vitrectomy. A specific cause was identified by vitreous analyses in 11 of 33 cases (33%). In seven eyes (21%) an infectious organism could be identified, in four eyes (12%) lymphoma was diagnosed from the biopsy.When stratifying patients by preoperative diagnosis, in 58% (7 of 12) of the suspected endophthalmitis cases a causative organism was identified. In the subgroup of suspected intraocular lymphoma only four of the nine cases (44%) were diagnosed by biopsy. In the subgroup of suspected endophthalmitis the visual acuity improved from a mean of 0,02 to a mean of 0,1 three months after surgery. In the subgroup of suspected uveitis cases the visual acuity improved from 0,1 preoperatively to a mean of 0,3 three months postoperatively.
We found overall improvement in visual acuity regardless of the underlying disease after vitrectomy. The identification of infectious organisms in suspected endopthalmitis was satisfactory and lead to adequate antibiotic therapy for the individual patient. Identifying specific organisms causing infectious uveitis and identifying lymphoma in highly suspicious cases was poor in our group of patients. This might be due to sample selection bias and sample size or to the quality of the obtained sample. In a general clinic it is mandatory to continuously improve sample quality and understanding of vitrectomy procedures in the pathology and microbiology departments in order to improve diagnostic yield.
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