gms | German Medical Science

With the advent of modern vitreoretinal surgical techniques the spectrum for surgical intervention in various forms of uveitis has been notably expanded. Removal of optically relevant vitreous opacities, improvement of secondary macular edema, delamination of epiretinal membranes and release of traction in presence of abnormal vitreoretinal adhesions represent indications for vitreoretinal procedures in uveitis patients.

A total of 60 publications from 1979 to 2003 on the topic of therapeutic vitrectomy were included into the analysis. 1728 patients had been included into all studies and 1934 eyes had been vitrectomized. All publications were analysed and compared concerning anatomical localization, functional results, influence on the activity of intraocular inflammation, preoperative risk factors, influence on macular edema, type of immunosuppression, number of combined procedures, postoperative complications as well as quality of life.

Subgroup analysis was performed to show trends although differences in study design made it difficult to compare results directly. The value of vitrectomy to treat chronic cystoid macular edema is still debated. There is only little data on the significance of adequate immunosuppression perioperatively.

So far no prospective, controlled clinical trials have been performed to precisely evaluate the role of pars plana vitrectomy as a single or combined surgical procedure in patients with intraocular inflammation. Inconsistent data exist regarding prognostic determinants and the role of perioperative immunosuppression. Here the current knowledge on the subject is reviewed, critically discussed and recommendations for patient management are given. Further studies are needed.