Elsevier

Ophthalmology

Volume 108, Issue 6, June 2001, Pages 1140-1144
Ophthalmology

Pars plana vitrectomy for cystoid macular edema secondary to sarcoid uveitis☆

https://doi.org/10.1016/S0161-6420(01)00558-9Get rights and content

Abstract

Objective

To examine the results of pars plana vitrectomy for cystoid macular edema secondary to sarcoid uveitis resistant to medical treatment.

Design

Retrospective, interventional, noncomparative case series.

Subjects

Fourteen consecutive subjects (18 eyes) with cystoid macular edema associated with sarcoid uveitis resistant to medical treatment.

Intervention

All eyes underwent pars plana vitrectomy. Nine eyes also underwent peeling of the epiretinal membrane or removal of the posterior vitreous cortex.

Main outcome measures

Status of macular edema, visual acuity, and complications.

Results

Ten eyes (56%) improved 2 or more lines of Snellen visual acuity within 12 months. Six eyes (33%) remained unchanged, within a line of preoperative Snellen visual acuity, and two eyes (11%) worsened by 2 or more lines of Snellen visual acuity. Slit-lamp biomicroscopy showed that cystoid macular edema had resolved in 14 eyes (78%) within 9 months postoperatively. One eye (6%) had minimal edema, whereas three eyes (17%) remained unchanged biomicroscopically at the final visit. Postoperative complications included cataract formation, glaucoma, optic nerve atrophy, epiretinal membrane formation, and tractional retinal detachment. No severe postoperative inflammation was noted.

Conclusions

Pars plana vitrectomy seems to have a beneficial effect on cystoid macular edema caused by sarcoidosis resistant to medical treatment.

Section snippets

Patients and methods

We reviewed the records of 14 consecutive subjects (18 eyes) with cystoid macular edema secondary to sarcoid uveitis who underwent pars plana vitrectomy at the Kyoto University Hospital from 1995 to 1998 (Table 1). Eleven patients had an established diagnosis of sarcoidosis on the basis of clinical findings and histologic confirmation by biopsy. Three patients, not subjected to biopsy, were diagnosed as having sarcoidosis by at least two of the following findings:17 (1) negative purified

Results

Ten eyes (56%) gained 2 or more lines of Snellen visual acuity at 1 to 12 months after surgery, and 10 eyes (56%) achieved visual acuity of 20/40 or better at the final visit (Fig 1). However, six eyes (33%) remained unchanged, and two eyes (11%) lost 2 or more lines of Snellen visual acuity.

Eight eyes underwent combined lensectomy vitrectomy; five of these eyes (63%) gained 2 or more lines of Snellen visual acuity at 1 to 12 months after surgery, and four of these eyes (50%) achieved visual

Discussion

Corticosteroid therapy is the primary treatment for cystoid macular edema caused by chronic uveitis. Visual improvement commonly occurs after periocular or systemic steroid treatment for cystoid macular edema caused by pars planitis,20 and most patients with sarcoidosis also respond favorably to this form of therapy.21 If the cystoid macular edema persists, or if periocular or systemic corticosteroid treatment is contraindicated, other therapeutic regimens need to be considered. Dugel and

References (31)

  • H Lewis et al.

    Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction

    Ophthalmology

    (1992)
  • T Hikichi et al.

    Role of the vitreous in the prognosis of peripheral uveitis

    Am J Ophthalmol

    (1993)
  • R.B Nussenblatt et al.

    Macular thickening and visual acuity. Measurement in patients with cystoid macular edema

    Ophthalmology

    (1987)
  • K Suzuma et al.

    Quantitative assessment of macular edema with retinal vein occlusion

    Am J Ophthalmol

    (1998)
  • C.J Johns et al.

    Sarcoidosis

    Annu Rev Med

    (1989)

    • Cited by (0)

    ☆

    Supported by a grant-in-aid for Scientific Research from the Ministry of Education, Science, and Culture, Japan.

    View full text
    Copyright © 2001 American Academy of Ophthalmology, Inc. Published by Elsevier Inc. All rights reserved.