NOV 09, 2007
By Russell W. Read, MD
Uveitis
This retrospective analysis included 44 patients (45 eyes) with suspected infection or malignancy who underwent vitrectomy for diagnosis. The authors report that a specific cause of intraocular cellular infiltration was found in 20 percent of patients, with an overall sensitivity of 63.6 percent. Flow cytometry had the highest sensitivity of tests performed (83 percent). However, despite vitrectomy and testing, two-thirds of cases remained idiopathic.
Probably most significantly, vision improved in 60 percent of eyes following vitrectomy, with 37.8 percent of eyes improving by three lines or more.
What isn't known is whether therapy was changed based on the results of biopsy. Perhaps some or all of the visual improvement can be explained by more aggressive therapy with anti-inflammatory drugs after infection or malignancy had been ruled out. The fact that eyes that remained idiopathic after vitrectomy had better acuity at all time points would support this possibility.
As a result, it’s unknown whether vitrectomy or enhanced medical therapy caused vision to improve. It is also unknown if some patients classified as idiopathic had infectious or malignant disease that was missed on initial vitrectomy and study. Indolent infectious processes such as P. Acnes are difficult to diagnosis, as are intraocular lymphoma, a confirmation of the latter not uncommonly requiring multiple vitreous samples or chorioretinal biopsy.