Ophthalmology department, Faculty of Medicine, Benha University, Benha City, Egypt.
Arq Bras Oftalmol. 2020 Sep-Oct;83(5):402-409. doi: 10.5935/0004-2749.20200079.
To compare the benefits and side effects of pars plana vitrectomy with those of systemic immune modulator therapy for patients with complicated intermediate uveitis.
This prospective clinical trial enrolled patients with recurrent intermediate uveitis who exhibited minimal improvement of visual acuity, despite injections of periocular steroids. Twenty patients were randomized to the pars plana vitrectomy group or oral steroid and cyclosporine-A group (10 eyes of 10 patients per group). Follow-up was performed for 24 months to study changes in visual acuity, binocular indirect ophthalmoscopy score, fluorescein angiography, and optical coherence tomography findings.
Visual acuity (logarithm of the minimal angle of resolution) significantly improved from 0.71 to 0.42 (p=0.001) in the surgical group, whereas it improved from 0.68 to 0.43 (p=0.001) in the immune modulator therapy group. Seven patients (70%) in the surgical group gained ≥2 lines, and six patients (60%) in the immune modulator therapy group gained ≥2 lines (p=0.970). Fluorescein angiography and optical coherence tomography studies showed that six of seven pars plana vitrectomy patients who had cystoid macular edema experienced improvement, whereas two patients with diffuse macular edema did not experience improvement. In the immune modulator therapy group, three of six patients with cystoid macular edema did not experience improvement, whereas two patients with diffuse macular edema experienced improvement.
Pars plana vitrectomy and immune modulator therapy resulted in significant improvement in visual function in patients with persistent inflammation secondary to chronic intermediate uveitis. Despite this success, there remains a need for the determination of optimal indications for the use of each modality. Immune modulator therapy was successful for the treatment of diffuse macular edema associated with chronic intermediate uveitis, whereas pars plana vitrectomy was not.
比较经睫状体平坦部玻璃体切除术与全身免疫调节剂治疗对慢性中间葡萄膜炎合并复发性中间葡萄膜炎患者的疗效和副作用。
本前瞻性临床试验纳入了中间葡萄膜炎反复发作的患者，这些患者尽管接受了眼周皮质类固醇注射，但视力仍无明显改善。20 名患者被随机分为睫状体平坦部玻璃体切除术组或口服皮质类固醇和环孢素 A 组（每组 10 名患者，共 10 只眼）。进行了 24 个月的随访，以研究视力、双眼间接检眼镜评分、荧光素血管造影和光学相干断层扫描结果的变化。
手术组视力（最小分辨角对数）从 0.71 显著提高至 0.42（p=0.001），而免疫调节剂治疗组从 0.68 提高至 0.43（p=0.001）。手术组 7 名（70%）患者视力提高≥2 行，免疫调节剂治疗组 6 名（60%）患者视力提高≥2 行（p=0.970）。荧光素血管造影和光学相干断层扫描研究显示，7 名睫状体平坦部玻璃体切除术后发生囊样黄斑水肿的患者中有 6 名得到改善，而 2 名弥漫性黄斑水肿患者未得到改善。免疫调节剂治疗组中，6 名发生囊样黄斑水肿的患者中有 3 名未得到改善，而 2 名弥漫性黄斑水肿患者得到改善。
睫状体平坦部玻璃体切除术和免疫调节剂治疗可显著改善慢性中间葡萄膜炎继发持续性炎症患者的视力功能。尽管取得了这一成功，但仍需要确定每种治疗方法的最佳适应证。免疫调节剂治疗对慢性中间葡萄膜炎伴弥漫性黄斑水肿的治疗有效，而睫状体平坦部玻璃体切除术无效。
