Vitrectomy for the diagnosis and management of uveitis of unknown cause
Vitrectomy for the diagnosis and management of uveitis of unknown cause
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DOI：
10.1016/j.ophtha.2007.01.038
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发表时间：
2007-10-01
期刊：
影响因子：
13.7
通讯作者：
Sears, Jonathan E.
中科院分区：
文献类型：
--
作者：
Margolis, Ron;Brasil, Oswaldo F. M.;Sears, Jonathan E.
目的：探讨怀疑眼内感染或恶性肿瘤的玻璃体液分析常用检查的诊断率。设计：非比较性介入病例系列。参与者：从1998年到2006年连续44例（45只眼睛）治疗后段炎症，并为诊断目的行玻璃体切割手术。干预措施：通过玻璃体切割获得的玻璃体标本进行微生物培养、细胞学分析和流式细胞术分析。主要结局指标：对玻璃体标本进行的每项检查的诊断率和灵敏度，以及行诊断性玻璃体切除术（DVx）的眼睛的视力结果。结果：术前诊断为感染15眼，恶性肿瘤30眼。总体而言，45只眼睛中有9只（20%）的玻璃体分析确定了特定的病因。DVx的总灵敏度为63.6%。个别试验的敏感性为：培养，50%；细胞学分析，66.7%；流式细胞术，83.3%。诊断试验的产率为：培养，5.7%；细胞学分析，14.3%；流式细胞术，20.6%。最终诊断为感染6眼，恶性肿瘤9眼，特发性30眼。DVx术后前6个月平均视力明显改善。60%的眼睛视力改善，37.8%的眼睛视力改善3线以上。结论：通过广泛使用的检测方法分析玻璃体液对鉴别眼内感染或恶性肿瘤是有用的。大多数患者的视力都有了很大的改善。
Purpose: To determine the diagnostic yield of tests commonly used for vitreous fluid analysis in eyes with suspected intraocular infection or malignancy.Design: Noncomparative interventional case series.Participants: Forty-four consecutive patients (45 eyes) treated from 1998 through 2006 with posterior segment inflammation who underwent pars plana vitrectomy for diagnostic purposes.Intervention: Vitreous specimens obtained via pars plana vitrectomy were analyzed by microbiologic culture, cytologic analysis, and flow cytometry.Main Outcome Measures: Diagnostic yield and sensitivity of each test performed on vitreous specimens and visual outcomes of eyes that underwent diagnostic vitrectomy (DVx).Results: Preoperative diagnoses were infection in 15 eyes and malignancy in 30 eyes. Overall, vitreous analysis identified a specific cause in 9 (20%) of 45 eyes. The overall sensitivity of DVx was 63.6%. The sensitivities of individual tests were: culture, 50%; cytologic analysis, 66.7%; and flow cytometry, 83.3%. The yields of diagnostic tests were: culture, 5.7%; cytologic analysis, 14.3%; and flow cytometry, 20.6%. Final diagnoses were infection in 6 eyes, malignancy in 9 eyes, and idiopathic in 30 eyes. Mean visual acuity improved significantly in the first 6 months after DVx. Visual acuity improved in 60% of eyes, with 37.8% of eyes improving by 3 lines or more.Conclusions: Analysis of vitreous fluid by widely available tests is useful in identifying intraocular infection or malignancy. Most patients experienced a substantial improvement in vision.