Ocular Inflammation and Choroidal Thickness after Pars Plana Vitrectomy in Chronic Recurrent Stage of Vogt-Koyanagi-Harada Disease

Coefficient of spatial variance of choroidal thickness on swept-source optical coherence tomography in healthy eyes

PURPOSE

This study aims to introduce the coefficient of spatial variance of choroidal thickness to describe the choroidal variation and investigate its associated factors in healthy eyes.

METHODS

This retrospective cross-sectional study included 1031 eyes from 1031 subjects who received a swept-source optical coherence tomography examination. The mean choroidal thickness in the macular 6 × 6 mm region and 900 subregions of 0.2 × 0.2 mm were computed using the embedded algorithm. Before analysis, potential segmentation and magnification errors were corrected. The coefficient of spatial variance was defined as the standard deviation divided by the mean (multiplied by 100%) of the choroidal thicknesses across 900 grids. Potential factors associated with the coefficient of spatial variance were assessed using multiple linear regression.

RESULTS

The mean choroidal thickness of the entire 6 × 6 mm macular region was 204.50 ± 72.88 μm. The mean coefficient of spatial variance was 26.58 ± 8.24%, ranging from 11.00 to 61.58%. Statistical analysis revealed that the means choroidal thickness (β = - 0.08, R2 = 0.42, p < 0.001) and anterior chamber depth (β = - 2.39, R2 = 0.05, p = 0.06) were associated with the coefficient of spatial variance.

CONCLUSION

Our study first incorporated the coefficient of spatial variance to represent the spatial variation of the choroidal thickness and observed that the greater thinning of the choroid is correlated with a more pronounced spatial variation.

Therapeutic Vitrectomy in the Management of Uveitis: Opportunities and Challenges

PURPOSE

Pars plana vitrectomy (PPV) has been traditionally used for diagnostic tapping or for management of posterior segment complications, in uveitis. The anti-inflammatory potential of therapeutic PPV, independent of its role in managing uveitis complications, is yet to be realised completely. In this narrative review, we have described the indications, surgical technique, and outcomes of therapeutic PPV in the management of uveitis.

METHODS

Literature review of PubMed database for articles relating directly or indirectly, to the anti-inflammatory effect of therapeutic PPV in the management of uveitis. Of the 876 articles retrieved on initial review, only 37 articles were found to be relevant for the purpose of this review.

RESULTS

Therapeutic PPV is effective in controlling vitreous inflammation, improving visual outcomes and reducing the need for immunosuppressive medications in a wide range of infectious and non-infectious uveitis. Careful patient selection and meticulous surgical handling are mandatory. Post-operative complications include cataract progression, raised intraocular pressure, hypotony, retinal breaks, and worsening of cystoid macular edema. Despite being introduced more than 40 years ago, most data on therapeutic PPV remain retrospective. The possibility of therapeutic PPV replacing conventional medical therapy remains unknown.

CONCLUSIONS

Therapeutic PPV can control intraocular inflammation, independent of its role in managing posterior segment complications of uveitis. However, its exact place in the anti-inflammatory armamentarium against uveitis remains uncertain.

Treatment outcomes of macular holes in the setting of uveitis: a scoping review

OBJECTIVE

We conducted a systematic review to evaluate the outcome of macular hole (MH) treatment in eyes with uveitis.

DATA SOURCE

We searched PubMed and Embase databases from inception through August 15, 2021.

STUDY SELECTION

We included eyes with MHs secondary to uveitis that were managed medically or underwent pars plana vitrectomy (PPV). We excluded eyes with idiopathic MH and those secondary to causes other than uveitis.

RESULTS

Of 27 articles, we identified 86 eyes with MH secondary to uveitis that received either conservative medical treatment alone or PPV with adequate follow-up. The mean (± SD) age of patients included in this review was 46.6 (± 16.8) years; 60.5% were males. The most common etiology of uveitis was Behçet's disease (34.6%) and toxoplasmosis (19.7%). The most common anatomical location of uveitis was posterior (59.3%) followed by panuveitis (35.2%). The mean (± SD) baseline LogMAR vision was 1.1 (± 0.5). Conservative medical treatment was employed in 34.9%, while PPV was performed in 65.1% of eyes. Overall, the mean (SD) LogMAR vision improved from 1.1 (± 0.5) at baseline to 0.7 (± 0.5) after treatment. Inflammation-related MHs were closed in 40% of eyes after conservative therapy and in 87.5% of eyes after PPV. Visual improvement occurred in most eyes (83.9%) that had successful closure of their MH.

CONCLUSIONS

Visual improvement occurs in most eyes that had successful closure of their inflammation-related MH. Conservative medical control of uveitis may lead to closure of inflammation-related MHs and is an important step prior to surgery, if required. Surgical intervention for inflammation-related MHs is associated with good functional and anatomical results.