*Department of Ophthalmology and †Department of Virology, University Medical Centre Utrecht, Utrecht, The Netherlands; and ‡Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Retina. 2014 Jan;34(1):108-14. doi: 10.1097/IAE.0b013e31828e6985.
To compare the yield of diagnostic pars plana vitrectomy (PPV) with the yield of aqueous analyses in patients with uveitis of unknown cause.
Seventy-five consecutive patients (84 eyes) with uveitis involving posterior eye segment who undergo a diagnostic PPV from 2005 through 2009 were retrospectively reviewed. Vitreous specimens were simultaneously analyzed by microbiological culture, flow cytometry, and cytology as well as by polymerase chain reaction and for intraocular antibody production by Goldmann-Witmer coefficient. In 53 eyes, both aqueous and vitreous samples were assessed. The primary outcome measure was the comparison between vitreous and aqueous analyses.
Vitreous analysis was positive in 18 of 84 eyes (21%). Positive results indicated infectious uveitis in 12 of 18 cases (67%) and lymphoma in 6 of 18 (33%) cases. Of the 53 eyes with both aqueous and vitreous samples available, aqueous analysis revealed the diagnosis in 6 of 53 eyes and vitreous in 9 of 53 eyes. Unilateral uveitis (P = 0.022), panuveitis and uveitis posterior (P ≤ 0.001), preoperative immunosuppressive therapy (P = 0.004), and increasing age (P = 0.018) were associated with an increased diagnostic yield of PPV. Overall, 1 year after PPV, median visual acuity improved from 20/200 to 20/80 (Snellen, P ≤ 0.001). Of 18 patients who were on immunosuppressive treatment before PPV, 8 (44%) were able to stop immunosuppressive therapy during 1-year follow-up. The complications of PPV consisted predominantly of cataract development (33/65, 51%).
Diagnostic PPV with the analysis of vitreous fluid by multiple laboratories for infectious and malignant disorders was useful in diagnosing uveitis of unknown cause. Previous aqueous analysis was especially valuable for the diagnosis of intraocular infections and may therefore decrease the number of patients who would otherwise undergo an invasive diagnostic PPV. Furthermore, PPV was associated with improved visual acuity and decreased use of immunosuppressive therapy.
比较对原因不明的葡萄膜炎患者行诊断性睫状体平坦部玻璃体切割术（PPV）与行房水分析的检出率。
回顾性分析 2005 年至 2009 年间行诊断性 PPV 的 75 例（84 只眼）累及后节葡萄膜炎患者的资料。同时对玻璃体标本进行微生物培养、流式细胞术、细胞学检查以及聚合酶链反应检测，并通过 Goldmann-Witmer 系数检测眼内抗体产生。在 53 只眼中，同时评估了房水和玻璃体样本。主要观察指标为玻璃体分析与房水分析的比较。
84 只眼中有 18 只（21%）玻璃体分析阳性。阳性结果提示 12 例（67%）为感染性葡萄膜炎，6 例（33%）为淋巴瘤。在 53 只同时具有房水和玻璃体样本的眼中，房水分析有 6 例（11%），玻璃体分析有 9 例（17%）。单侧葡萄膜炎（P = 0.022）、全葡萄膜炎和后葡萄膜炎（P ≤ 0.001）、术前免疫抑制治疗（P = 0.004）和年龄增长（P = 0.018）与 PPV 诊断率的提高相关。总体而言，PPV 后 1 年，视力从中度视力损害（20/200）改善至较好视力（20/80）（Snellen，P ≤ 0.001）。在术前接受免疫抑制治疗的 18 例患者中，有 8 例（44%）在 1 年随访期间能够停止免疫抑制治疗。PPV 的并发症主要为白内障形成（33/65，51%）。
对原因不明的葡萄膜炎患者行诊断性 PPV 并对玻璃体液进行多实验室分析以排除感染性和恶性疾病，对诊断具有重要价值。先前的房水分析对眼内感染的诊断特别有价值，因此可以减少需要进行侵入性诊断性 PPV 的患者数量。此外，PPV 还可提高视力并减少免疫抑制治疗的应用。
