Pars plana vitrectomy assisted by triamcinolone acetonide for refractory uveitis: a case series study

Abstract

Aim: To examine the outcome of a triamcinolone acetonide (TA) assisted pars plana vitrectomy (PPV) for refractory uveitis.

Methods: Six patients suffering from proliferative vitreoretinopathy (PVR) with refractory uveitis underwent a TA assisted PPV. The patients consisted of one with Vogt-Koyanagi-Harada disease, one with acute retinal necrosis, one with Behçet's disease, and three with sarcoidosis. TA was inoculated into the vitreous cavity to visualise the vitreous. In four of six patients, 4 mg of TA were intentionally left in the vitreous cavity to reduce the degree of postoperative inflammation.

Results: The vitreous body was clearly seen using TA during surgery, which greatly helped us to perform a posterior hyaloid resection safely and thoroughly. As we previously observed in other disease, TA allowed us to visualise the transparent vitreous and thus was helpful in removing the vitreous cortex from the retina completely in uveitis. One patient (Behçet's disease, in whom TA was intentionally left) showed an elevated intraocular pressure (IOP) transiently after surgery which was controllable by topical eye drops. The remaining TA diminished day by day and had almost completely disappeared within a month from operation.

Conclusion: TA improved the visibility of the hyaloid and the safety of the surgical procedures and no serious complications were observed after TA assisted PPV in uveitis. Although the long term effects are still unknown, this method appears to be potentially useful as an improved treatment for PVR associated with refractory uveitis.

Figure 1

Intraoperative findings regarding the removal of the residual vitreous cortex (case 1). (A) A thin hyaloid membrane (arrow) is left on the posterior retina even after the surgical posterior hyaloid separation. The edge of this hyaloid is held with a surgical forceps (arrow). (B) The membrane is gradually removed. (C) The macular area (arrow) is then free from the residual vitreous cortex.

Figure 2

A series of fundus photographs before and after TA assisted PPV (case 2, in whom 4 mg of TA was intentionally left post-PPV). (A) The fundus photograph on 17 April 2002 (before PPV). The details of the fundus were completely obscure. PPV was performed on 23 April and 4 mg of TA was intentionally left to control postoperative inflammation. (B–F) The fundus photographs post-PPV. (B) 24 April (the day after PPV), (C) 28 April, (D) 5 May, (E) 10 May, (F) 15 July. The details of the ocular fundus including laser photocoagulation spots can be observed. In addition, the remaining amount of TA (white material) gradually decreased until it had almost disappeared by 10 May (23 days after PPV) and thereafter completely disappeared before 15 July.

Figure 3

The representative photographs of fluorescein angiography after TA assisted PPV (cases 3 (A), 4 (B), and 6 (C)). All photographs were taken 2 months after PPV.