Outcomes of Primary 27-Gauge Vitrectomy for 73 Consecutive Cases With Uveitis-Associated Vitreoretinal Disorders

Abstract

Background: Since the advent of 27-gauge microincision vitrectomy system a decade ago, evidence regarding the feasibility, safety, and effectiveness of 27-gauge pars plana vitrectomy (PPV) has increased.Aim: To assess the effectiveness and safety profile of 27-gauge PPV for various vitreoretinal conditions associated with uveitis.Methods: We retrospectively investigated 73 consecutive cases that underwent primary 27-gauge PPV for uveitis-related ocular disorders between October 2014 and April 2021. The primary outcome measures were mean change in logMAR best-corrected decimal visual acuity (BCVA) pre-operatively to 3 months post-operatively, the proportion of BCVA improvement category defined as the degree of logMAR BCVA difference (“improved” [≤−0.3], “unchanged” [−0.3 to 0.3], and “worsened” [≥0.3]) pre-operatively to 3 months post-operatively, the mean change in intraocular inflammation scores pre-operatively to 3 months post-operatively; and intraoperative and post-operative complications.Results: The mean logMAR BCVA significantly improved from 0.69 pre-operatively to 0.42 at 3 months post-operatively (P = 0.017). The percentages of eyes with “improved,” “unchanged,” and “worsened” BCVA at 3 months post-operatively were 37, 50, and 13%, respectively. The mean anterior chamber cell score was 0.6 pre-operatively and 0.2 at 3 months post-operatively (P = 0.001), the mean anterior chamber flare score was 0.4 pre-operatively and 0.1 at 3 months post-operatively (P = 0.004), and the mean vitreous haze score was 1.9 pre-operatively and 0.1 at 3 months post-operatively (P < 0.001). Surgery-related complications occurred in 35 (48%) eyes, 68% of which were related to intraocular pressure and transient.Conclusions: Given its risk–benefit profile, 27-gauge PPV is a promising option for the treatment of vitreoretinal disorders in uveitis.

Outcomes of pars plana vitrectomy in the management and diagnosis of patients with infectious, non-infectious, and unidentified uveitis

“…This lower incidence compared to the study of Svozilkova et al [ 3 ] could be explained by the use of 23-gauge PPV. On the other hand, this incidence seems less favorable than in studies with 25- or 27-gauge PPV [ 10 , 31 ]. Consequently, surgery-related complications are major concerns related to intraocular surgery in inflamed eyes.…”

“…Epiretinal and epiciliary membranectomy, 360° scleral indentation, vitreous base dissection, or intraocular tamponade injection with PPV is crucial in preventing common postoperative complications such as hypotonia, RD, or ERM [ 28 – 30 ]. The most frequently reported early complications are unusual intraocular pressure responses [ 10 , 31 ]. Although we performed the requisite surgical procedures to avoid these complications, consistent with other studies, increased intraocular pressure and transient hypotonia developed most frequently in the early period of this study.…”

Outcomes of Microhook ab Interno Trabeculotomy in Consecutive 36 Eyes with Uveitic Glaucoma

“…In a retrospective study analyzing 1076 patients with uveitis between 2011 and 2013, secondary glaucoma, along with chronic cystoid macular edema, macular scarring, and epiretinal membrane, is a cause of moderate or severe vision loss [9]. With the advent of tumor necrosis factor-alpha inhibitors and the advances in the surgical system, ocular complications other than secondary glaucoma could be better managed in recent years [10][11][12][13][14]. Accordingly, uveitic glaucoma is becoming more important as a major cause of vision loss.…”