Massachusetts Eye Research and Surgery Institution, Cambridge, MA, USA.
Ocul Immunol Inflamm. 2010 Oct;18(5):411-7. doi: 10.3109/09273948.2010.501132.
Comparison of pars plana vitrectomy (PPV) with immunomodulatory therapy (IMT) for patients with intermediate uveitis (IU).
A prospective, randomized pilot study was performed on patients with recalcitrant IU associated with degradation of visual acuity (VA) despite standard treatment. Outcome measures (VA, intraocular pressure, anterior chamber and vitreous cellular infiltrate) were collected.
Sixteen patients (18 eyes) were randomized to the PPV IMT group. Nine of 11 eyes (82%) treated with PPV showed resolution of inflammation at follow-up, at 5.93 years. Four of 7 eyes (57%) given IMT had persistent inflammation requiring subsequent PPV. PPV patients showed greater improvement in Snellen line, IOP, and vitreous cell reduction. Three PPV patients had cystoid macular edema (CME) initially; all resolved postoperatively. CME improved in 2 of 3 eyes using IMT.
A higher percentage of patients treated with PPV had improvement of uveitis compared to those given IMT. A multicentered clinical trial is needed to confirm and statistically validate these conclusions.
比较睫状体平坦部玻璃体切除术（PPV）与免疫调节治疗（IMT）治疗中间葡萄膜炎（IU）患者的效果。
对伴有标准治疗后视力（VA）下降的难治性 IU 患者进行了一项前瞻性、随机的初步研究。收集了结局指标（VA、眼压、前房和玻璃体细胞浸润）。
16 名患者（18 只眼）被随机分为 PPV-IMT 组。11 只眼（82%）接受 PPV 治疗的眼在 5.93 年的随访时炎症得到缓解。7 只眼（57%）接受 IMT 治疗的眼持续存在炎症，需要随后进行 PPV。PPV 患者的 Snellen 线视力、眼压和玻璃体细胞减少改善更明显。3 例 PPV 患者最初有黄斑囊样水肿（CME），均术后缓解。3 只眼使用 IMT 后 CME 改善。
与接受 IMT 治疗的患者相比，接受 PPV 治疗的患者的葡萄膜炎改善比例更高。需要进行多中心临床试验来证实和统计验证这些结论。
