Value of Diagnostic Vitrectomy in Impacting Clinical Management

Abstract

Purpose : Diagnostic vitrectomy can provide useful information in cases of intraocular inflammation or opacity in which initial work-up has failed to elucidate an underlying etiologic process. Studies have reported a wide range of diagnostic yields, but few have focused on the impact of results on clinical course/management. We hypothesized that patients in whom diagnostic vitrectomy directly impacts subsequent clinical management will have different visual outcomes than patients in whom it does not. Furthermore, we aimed to provide up-to-date information about the rates of positive infectious, inflammatory, and neoplastic diagnostic vitrectomy results.

Methods : A retrospective chart review of the patients who underwent diagnostic pars plana vitrectomy and vitreous biopsy from January 2015 through April 2021 was performed. Baseline characteristics including presumptive diagnosis was collected from the charts and compared with final pathology reports to assess the role of diagnostic vitrectomy. Visual acuities were recorded immediately pre-operatively, at post-operative months 1, 6, and 12, and at the final visit. Changes in visual acuity relative to pre-op were calculated. The microbiologic and pathologic results of each vitrectomy sample were reviewed, the final post-op diagnosis was recorded and categorized by etiologic subtype, and the patients in whom the results led to significant change in diagnosis and/or clinical management were identified.

Results : A total of 117 eyes of 117 patients (57.3% female, mean (±SD) age 63.2 (±18.7); range 4-93 years) were included in this study. Patient characteristics, follow-up, and procedure gauge are summarized in Table 1. The mean (±SD) pre-vitrectomy logMAR visual acuity was 1.20 (±0.95) and mean (±SD) 1 month post-vitrectomy logMAR visual acuity was 0.97 (±0.93; p=0.046), The mean (±SD) 6 month post-vitrectomy logMAR visual acuity was 0.93 (±0.91; p=0.023). Analysis of vitrectomy results and impact on clinical management is presented in Table 2. In 24.8% of cases, vitrectomy result led to change in clinical management.

Conclusions : Diagnostic vitrectomy results lead to a change in clinical management in a minority of cases. Prognosis for visual outcome in these cases may be poorer, possibly due to more severe conditions being more likely to yield positive results. Neoplastic etiologies tend to be underestimated clinically prior to diagnostic vitrectomy.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.