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P. S. Mettu, S. K. Srivastava, P. Mruthyunjaya, S. Bressler, S. Stinnett, R. M. McCallum, G. J. Jaffe; Surgical Management in Patients With Uveitis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3914.
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To investigate the role of ocular surgery in the diagnosis and management of uveitic diseases and their sequelae.
Charts of patients with initial visits to the Duke University Eye Center between January 1989 and December 1999 were retrospectively reviewed to ascertain the types and incidence of ocular surgery for the management of uveitic disease and associated sequelae. Data on patient ethnicity, age, gender, and diagnosis of clinical sub-type of uveitis were recorded, along with data on past ocular history and all prior eye surgeries. Rates of ocular surgery performed for management of uveitis were determined and analyzed in total and by clinical sub-type of uveitis.
Of 606 patients presenting for evaluation and management of uveitis, 168 (27.6%) patients underwent at least one type of surgical procedure. Ninety-seven (16.1%) patients underwent vitreoretinal surgery, 25 (4.1%) of whom had vitrectomy done at least in part for diagnostic purposes, and six (1.0%) of whom had implantation of a sustained-release drug depot. Eighty-eight (14.5%) patients underwent at least one cataract/lens extraction, and thirty (5.0%) patients underwent bilateral cataract/lens extraction. Thirty-five (5.8%) patients underwent surgical procedures to lower intraocular pressure or improve aqueous flow, and nine (1.5%) patients underwent peripheral iridectomy. Thirty-seven (6.1%) patients underwent retinal laser treatment either alone or as part of vitreoretinal surgery. Patients with HLA-B27-associated uveitis (11.4% of non-surgical patients as compared to 3.0% of surgical patients), anterior uveitis of unknown etiology (14.8% as compared to 5.4%), and intermediate uveitis of unknown etiology (9.6% as compared to 3.6%) were less likely to undergo surgery related to their uveitis disease. Patients with panuveitis of uncertain etiology (16.0% of surgical patients as compared to 8.4% of non-surgical patients), sarcoidosis (14.9% as compared to 6.2%), and presumed ocular histoplasmosis syndrome (5.4% as compared to 0.5%) were more likely to undergo surgery related to their uveitis disease.
Ocular surgery, including vitreoretinal procedures, cataract removal, glaucoma procedures, and retinal laser, are performed commonly in patients with uveitis. The frequency of surgery depends on the specific uveitic subtype. These procedures are integral to the diagnosis and management of ocular inflammatory disease and its sequelae.
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