Purpose:

Intermediate uveitis occurs in about 8-39% of uveitis cases in patients at the age of 30 and younger. The purpose of this study was to evaluate the efficacy of pars plana vitrectomy (PPV) in controlling the inflammation in eyes with recurrent intermediate uveitis.

Methods:

We evaluated retrospectively the results of PPV for intermediate uveitis in young patients (6 children, 1 young adult) who had a minimum follow-up of 3 years (median observation periodĀ : 8 years) in six children (median ageĀ : 8 years) and one young adult (25 years). PPV was performed after at least two episodes of intermediate uveitis. Ten eyes also had peripheral cryotherapy of the lower inferior retina. Furthermore, cystoid macular edema was diagnosed in 8 eyes of 5 children (bilaterally in 3, unilaterally in 2 patients). The young adult also had bilateral cystoid macular edema. Data analysis included peri- or post-operative PPV-complications, anatomical and functional results and relapse of intermediate uveitis after PPV.

Results:

We evaluated fourteen eyes in 7 patients (12 eyes in six children and 2 eyes in one adult). Five eyes received an encircling band prior to the PPV procedure. Conventional PPV was performed and a vitreous sampling taken for laboratory examination A complete vitrectomy with PVD was attempted in all cases; one case received 4 mg triamcinolone postoperatively. No peri- or postoperative complications were noted. Five children who had undergone PPV in one eye were treated with systemic immunosuppressants for a recurrent episode of uveitis in the fellow eye. One patient was also treated with systemic antiprotozoal agents due to intravitreally positive IgG antibodies against toxoplasma gondii. All other bacterial, viral, mycotic tests from the vitreous TAP were negative. Two eyes underwent peripheral cryotherapy of the inferior part of the retina after PPV. Six eyes were operated on for secondary posterior subcapsular cataracts. As a 7-year old boy had a relapse of uveitis in left eye 11 months after PPV, we decided to perform an intravitreal injection with 4 mg triamcinolone. Furthermore, one patient developed recurrent cystoid macular edema in the right eye 8 years after PPV, and an intravitreal dexamethasone implant (Ozurdex) application is planned (see OCT of child 4). Average pre-operative visual acuity was 0.32 and improved to 0.8.

Conclusions:

Severe intermediate uveitis is difficult to treat medically alone. PPV for recurrent intermediate uveitis, in particular associated with cystoid macular edema, proved to be effective in achieving long-term disease regression, in improving visual acuity and on reducing the need for systemic immunosuppression.