gms | German Medical Science

Background: To assess the diagnostic value of air vitrectomy in severe intraocular inflammatory diseases of unknown origin.

Patients and Methods: Records of patients who underwent diagnostic vitrectomy were retrospectively reviewed. 86 patients with 1. clinical suspicion of vision or life threatening intraocular disease like viral retinitis, endogenous fungal endophthalmitis or intraocular lymphoma, or 2. atypical course of intraocular inflammation or inadequate response to empirical therapy were included. Exclusion criteria were immunosuppression, purulent infections of the anterior segment, and history of an intraocular foreign body or intraocular surgery during the last 7 days. To obtain a sufficient amount of undiluted vitreous specimen (>3 ml) vitrectomy was performed under air infusion. In selected cases an additional retinal biopsy was done. Specimen were sent for microbiological, virological and pathological analysis.

Results: By vitrectomy alone or in combination with retinal biopsy an intraocular lymphoma was diagnosed in 5 of 86 patients and suspected in another 2 patients. Infectious causes were identified in 28 of 86 patients with viruses of the human herpes group as the most prevalent cause (21 of 86). The most precise clinical diagnosis was achieved in patients with viral retinitis, while patients with unclear panuveitis and clinical suspicion of intraocular lymphoma were tested less often positive.

Conclusion: Diagnostic vitrectomy is a safe and useful procedure in the clinical management of possibly vision or life threatening inflammatory eye diseases. Air vitrectomy assures a large amount of undiluted vitreous specimen.