Vitrectomy in multifocal chorioretinitis.

In nine patients suffering from multifocal chorioretinitis with panuveitis, we obtained no impressive therapeutic benefit from vitrectomy. Seven women and two men ranging in age from 63 to 86 years underwent pars plana vitrectomy at 3-28 months after the first signs of uveitis had appeared. Previous medical treatment had always been unsuccessful. Vitrectomy was performed in one eye of eight patients and in both eyes of one patient. In addition, in two patients a cataract was removed by phacoemulsification and an intraocular lens was implanted. A visual improvement of one or two lines was achieved postoperatively in most cases, but the visual acuity decreased to preoperative values or less within 6 months. The surgical treatment showed no obvious effect on the intensity or frequency of uveitis relapse. In all cases, vitrectomy specimens were serologically negative for herpes-group viruses. Histologically, no malignancy was detectable. Immunohistochemistry studies revealed that a large number of the vitreous cells bore T-lymphocyte markers (mostly CD2-, CD3-, and CD4-positive); about one-third of the vitreous cells were macrophages, and B-lymphocytes were only rarely detected. In conclusion, pars plana vitrectomy in multifocal chorioretinitis achieved no positive long-term result. There was no diagnostic hint as to whether the cause of the uveitis might have been of a viral, malignant, or autoimmune origin. Therefore, multifocal chorioretinitis remains poorly understood in terms of its etiology and adequate treatment.