Macular vessel densities by optical coherence tomography angiography in patients with intermediate uveitis

Purpose: To evaluate the macular microvascular changes in patients with intermediate uveitis (IU) using optical coherence tomography angiography (OCT?A) and to determine the relationship of OCT?A measurements with disease duration and activity. Methods: This cross?sectional study was performed at the uvea department of a tertiary hospital. Patients with IU (8 women, 8 men; mean age: 28.80 ± 12.80 years) were included in the study. The macular thickness measurements obtained by optical coherence tomography (OCT) (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany) and macular superficial and deep vessel density (VD) parameters obtained by OCT?A (Avanti RTVue?XR; Optovue, Fremont, CA, USA) were compared with healthy subjects (12 men, 22 women; mean age: 28.40 ± 8.32 years). Eyes with pathology including marked obvious edema in the macula were not included in the study. Results: The macular thickness was found to be higher in the patient group (p < 0.001). The deep and superficial VD measurements in almost all quadrants in both superficial and deep layers were significantly lower in the IU patient group (p < 0.05). Macular thickness was increased in the active state of IU (p = 0.03), however, none of the OCT?A parameters showed a significant difference between active and inactive IU patients (p > 0.05). No correlation was observed between OCT?A parameters and total IU disease duration. Conclusion: Quantitative analyses of macular vascular structures demonstrate significantly reduced VD in both superficial and deep retinal layers in IU patients. Considering the importance of the macula in visual prognosis, OCT?A can provide crucial data for the monitoring and follow?up of IU patients.

Prevalence, clinical profile, investigations, and visual outcome of sarcoid intermediate uveitis in a tertiary eye care center in South India

Purpose: To report the prevalence, clinical profile, investigations, and visual outcomes of sarcoid intermediate uveitis in a tertiary eye care center in South India. Methods: Retrospective, observational case series. Records of 29 patients with sarcoid intermediate uveitis were retrieved. Complete ophthalmic evaluation and systemic examination by a pulmonologist with appropriate laboratory investigations were done. Results were analyzed using SPSS software. Results: Mean age group was 42.14 ± 11.31 years. The bilateral presentation was more common and females were more affected than males. Anterior chamber cells and flares in 22.4% of cases (N = 11 eyes), posterior synechiae in 20.4% (N = 10 eyes), and both small and mutton fat keratic precipitates in 14.2% of cases (N = 7 eyes) were noted; only one eye had Busacca nodules similar to other granulomatous uveitis. Cystoid macular edemas were present in three eyes. Treatment with oral steroids and systemic immunosuppression resulted in good visual recovery. The mean presenting visual acuity in right and left eye were 0.2 and 0.3, respectively. The mean final visual acuity in right and left eye was 0.1 and 0.3, respectively. Conclusion: Sarcoid intermediate uveitis is quite common in a tuberculosis endemic country like India. A complete review of systems with appropriate investigations is essential to prevent visual complications

Pattern of uveitis from a tertiary eye care center in Himalayan belt of North India

Purpose: To study the clinical characteristics of uveitis in patients presenting to a tertiary care institute in the northern part of India, predominantly serving the population of Himalayan belt. Methods: In this retrospective descriptive case series, data of 141 eyes of 102 patients diagnosed between January 2019 and January 2021 were analyzed. Patients were diagnosed, named, and meshed as per the Standardization of Uveitis Nomenclature. A panel of investigations (systemic and ocular ancillary investigations) were done, which was individualized according to the clinical picture. Results: The mean age of presentation was 39.1 ± 14.62 years. A male predominance (62.7%) was noted. Unilateral presentation was seen in 61.8% of patients. Specific etiological diagnosis was not reached in 56.7% of cases. The incidence of infectious and noninfectious uveitis was 23.4% and 19.9%, respectively. The frequency of anterior, intermediate, posterior, and panuveitis was 23.4%, 11.3%, 46.8%, and 18.5%, respectively. Posterior uveitis was the most frequent anatomical location (46.8%). Tuberculous uveitis was the most common definitive etiology irrespective of location (18.5%). Anterior, intermediate, and posterior uveitis were more frequently idiopathic in origin. Sympathetic ophthalmitis was the most common cause for panuveitis. Conclusion: Uveitis significantly affected the working age group population. Despite the evolution of diagnostic investigations, etiology remained unknown in many cases of uveitis. Infectious etiology was more common. Posterior uveitis as the most frequent anatomical location in our study may be attributed to the tertiary care referral bias.

An analysis of the clinical profile of patients with uveitis following COVID-19 infection

Purpose: To describe the clinical profile of patients presenting with uveitis following COVID?19 infection at a tertiary care eye hospital in South India. Methods: In this retrospective chart review, all consecutive cases presenting with an acute episode of intraocular inflammation and a history of COVID?19 infection diagnosed within the preceding 6 weeks, between March 2020 and September 2021, were included. Data retrieved and analyzed included age, sex, laterality of uveitis, and site of inflammation. The diagnosis was categorized based on the SUN working group classification criteria for uveitis. Details regarding clinical features, investigations, ophthalmic treatment given, response to treatment, ocular complications, and status at last visit were also accessed. Statistical analysis of demographical data was done using Microsoft Excel 2019. Results: Twenty?one eyes of 13 patients were included in this hospital?based retrospective observational study. The study included six male and seven female patients. The mean age was 38 ± 16.8 years. Eight patients had bilateral involvement. Seven patients were diagnosed with anterior uveitis, three with intermediate uveitis, one with posterior uveitis, and two with panuveitis. All patients responded well to treatment and were doing well at their last visit. Two patients had complications that necessitated surgical treatment, following which they recovered good visual outcomes. Conclusion: With prompt diagnosis and appropriate management, all the patients with uveitis post?COVID?19 infection recovered with good visual outcomes. Thus, ophthalmologists must be aware of the possible uveitic manifestations following even uneventful COVID?19 infection

Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study / Terapia com imunomodulador ou vitrectomia para manejo de uveíte intermediária complicada: estudo clínico prospectivo e randomizado

ABSTRACT Purpose: To compare the benefits and side effects of pars plana vitrectomy with those of systemic immune modulator therapy for patients with complicated intermediate uveitis. Methods: This prospective clinical trial enrolled patients with recurrent intermediate uveitis who exhibited minimal improvement of visual acuity, despite injections of periocular steroids. Twenty patients were randomized to the pars plana vitrectomy group or oral steroid and cyclosporine-A group (10 eyes of 10 patients per group). Follow-up was performed for 24 months to study changes in visual acuity, binocular indirect ophthalmoscopy score, fluorescein angiography, and optical coherence tomography findings. Results: Visual acuity (logarithm of the minimal angle of resolution) significantly improved from 0.71 to 0.42 (p=0.001) in the surgical group, whereas it improved from 0.68 to 0.43 (p=0.001) in the immune modulator therapy group. Seven patients (70%) in the surgical group gained ≥2 lines, and six patients (60%) in the immune modulator therapy group gained ≥2 lines (p=0.970). Fluorescein angiography and optical coherence tomography studies showed that six of seven pars plana vitrectomy patients who had cystoid macular edema experienced improvement, whereas two patients with diffuse macular edema did not experience improvement. In the immune modulator therapy group, three of six patients with cystoid macular edema did not experience improvement, whereas two patients with diffuse macular edema experienced improvement. Conclusions: Pars plana vitrectomy and immune modulator therapy resulted in significant improvement in visual function in patients with persistent inflammation secondary to chronic intermediate uveitis. Despite this success, there remains a need for the determination of optimal indications for the use of each modality. Immune modulator therapy was successful for the treatment of diffuse macular edema associated with chronic intermediate uveitis, whereas pars plana vitrectomy was not.

RESUMO Objetivo: Comparar os benefícios e efeitos co laterais da vitrectomia via pars plana com os da terapia imunomo duladora sistêmica em pacientes com uveíte intermediária complicada. Métodos: Estudo clínico prospectivo incluiu pacientes com uveíte intermediária recorrente que apresentaram melhora minima da acuidade visual, apesar das injeções perioculares de esteroides. Vinte pacientes foram randomizados para o grupo de vitrectomia via pars plana ou esteróide oral e ciclosporina A (10 olhos de 10 pacientes por grupo). O acompanhamento foi de 24 meses para estudar al te rações na acuidade visual, o escore da oftalmoscopia binocular indireta, a angiofluoresceinografia e achados na to mográfica de coerência óptica. Resultados: A acuidade visual (logaritmo do ângulo mínimo de resolução) melhorou significativamente de 0,71 para 0,42 (p=0,001) no grupo cirúrgico, enquanto melhorou de 0,68 para 0,43 (p=0,001) no grupo da terapia imunomoduladora. Sete pacientes (70%) no grupo cirúrgico ganharam ≥2 linhas e seis pacientes (60%) no grupo da terapia imunomoduladora ganharam ≥2 linhas (p=0,970). Os estudos de angiofluoresceinografia e tomografia de coerência óptica mostraram que seis dos sete pacientes da vitrectomia via pars plana que apresentaram edema macular cistóide melhoraram, enquanto dois pacientes com edema macular difuso não apresentaram melhora. No grupo da terapia imunomoduladora, três dos seis pacientes com edema macular cistoide não apresentaram melhora, enquanto dois pacientes com edema macular difuso melhoraram. Conclusões: A vitrectomia via pars plana e a terapia imunomoduladora resultaram em melhora significative da função visual dos pacientes com inflamação persistente secundária a uveíte intermediária crônica. Apesar desse sucesso, continua sendo necessário determinar as melhores indicações para o uso de cada modalidade. A terapia imunomoduladora foi bem sucedida no tratamento do edema macular difuso associado à uveíte intermediária crônica, enquanto a vitrectomia via pars plana não foi.

Active uveitis induces transient refractive error changes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the impact of active uveitis on refractive error changes.<p>METHODS: A prospective cohort study was conducted on 66 patients(88 eyes)with active uveitis. The subjects were classified based on the anatomical location of their disease activity as anterior, intermediate, posterior and pan-uveitis. Cycloplegic refraction was performed in both active and quiescent phases, and the results were compared. <p>RESULTS: Spherical changes in active anterior non-granulomatous uveitis resulted in an average of -0.25(0.77)D(95%<i> CI</i>: -0.5 to 0)shift toward myopia(<i>P</i>=0.039)and in active intermediate uveitis, an average of +0.39(0.8)D(95% <i>CI</i>: 0.09-0.69)shift toward hyperopia(<i>P</i>=0.003). Spherical equivalent changes in active intermediate uveitis resulted in hyperopic shift \〖+0.43(0.94)D, 95% <i>CI</i>: 0.08-0.79, <i>P</i>=0.005\〗. Cylinder had only significant changes in pan-uveitis \〖-0.3(0.39)D, 95% <i>CI</i>: -0.58 to -0.02, <i>P</i>=0.043\〗. In multivariate analysis, we noted that course of disease activity(acute versus recurrent)and anatomical location of disease activity had statistically significant effects on spherical equivalent changes(<i>P</i>=0.003 and <i>P</i>=0.004, respectively).<p>CONCLUSION: Active uveitis has a significant effect on the refractive status of the eye, the changes of which depend on the inflamed anatomical area.

Comparative study on clinical course and prognosis of intermediate uveitis in children and adults / 眼科新进展

Objective To explore the clinical process and prognosis of middle and intermediate uveitis in children and adults.Methods A total of 121 patients with intermediate uveitis admitted to our hospital from January 2012 to December 2014 were enrolled in the study.Among them,there were 67 cases with monocular involvement and 54 cases with binocular involvement;59 cases were children and 62 cases were adults.All subjects were treated with personalized regimen according to the severity of the disease.The treatment effects and prognosis were compared between patients with different ocular involvement,children and adults.Results The total effective rate of treatment in patients with monocular involvement,children,patients with binocular involvement and adults were 92.5％,93.2％,92.6％ and 91.9％,respectively (all P ＞ 0.05).There was no significant difference in acute phase protein and visual acuity between the patients with ocular involvement and children,adults before treatment (all P ＞ 0.05),and there was no significant difference in the indexes between two groups after treatment (all P ＞ 0.05).The acute phase protein in each group after treatment was decreased,and the visual acuity was obviously increased,there were statistical differences before and after treatment (all P ＜ 0.05).Conclusion Individualized treatment regimen for patients with intermediate uveitis can improve the therapeutic effect,control inflammation and improve visual acuity.The curative effect is not significantly related to age and degree of ocular involvement.

Intermediate uveitis – a review.

Intermediate Uveitis (IU) is an inflammatory disease, primarily involving the vitreous and peripheral retina. It accounts for around 8% of cases of uveitis and affects primarily children and young adults. The etiology is unknown but, found as an isolated and idiopathic condition or in association with systemic disorders such as multiple sclerosis and sarcoidosis and infectious diseases. Symptoms include painless blurring of vision, floaters and deterioration of vision. Clinical features seen are anterior segment affection with keratic precipitates and anterior chamber cells, vitritis, vasculitis in the peripheral retina, vitreal snow banks and cystoid macular edema (CME). CME was the major threat for deterioration of vision; other complications include vitreous haemorrhage, periphlebitis, cataract and glaucoma. Treatment of intermediate uveitis is based on periocular and oral corticosteroids. Cryotherapy or laser photocoagulations of the peripheral retina are options in patients when there is an insufficient response to periocular or systemic corticosteroids. Immunomodulatory therapy is used when other therapies fail. Pars plana vitrectomy (PPV) is indicated in patients with chronic significant inflammation, non-responsive cystoid macular edema, non-clearing vitreous haemorrhage, tractional retinal detachment and epiretinal membranes. IU is an intraocular inflammation involving the anterior vitreous, peripheral retina and pars plana. It usually affects patients from 5 to 30 years old, without gender or racial preferences. The etiology is unknown but there are several associated diseases. The long-term prognosis of intermediate uveitis is usually good, particularly with strict control of inflammation and with proper management of complications.

Efficacy of Ozurdex implant in treatment of noninfectious intermediate uveitis.

Aims: To report our experiences using Ozurdex, a biodegradable implant, containing 0.7 mg of dexamethasone in the treatment of noninfectious intermediate uveitis. Settings and Design: Retrospective study design. Methods: We conducted a retrospective study of medical records of patients with noninfectious intermediate uveitis having either cystoid macular edema (CME) or vitritis who were not responsive to standard treatment and subsequently received Ozurdex implant from March 2011 to April 2013. The outcomes measured were best‑corrected visual acuity, central retinal thickness (CRT), and vitreous haze score. Statistical Analysis Used: Paired t‑test was used to test the significance of difference between quantitative variables. A P < 0.05 is taken to denote significant relationship. Results: Twenty eyes of 15 patients with mean age of 39.8 years who received Ozurdex implant were included in the study. The mean baseline visual acuity improved from 0. 666 logarithm of the minimum angle of resolution (logMAR) units to 0.479 logMAR units at 6 weeks after the implant. The mean CRT improved from 536.1 to 361.4 microns at 6 weeks postimplant both parameters were statistically significant. The ocular inflammation was controlled in almost all the patients. Cataract and raised intraocular pressure were documented complications. Conclusion: Ozurdex implant is a promising treatment option and efficient in controlling the inflammation and CME in cases of noninfectious intermediate uveitis not responding to standard treatment.

DNA chip-assisted diagnosis of a previously unknown etiology of intermediate uveitis – Toxoplasma gondii.

We report the use of DNA chip technology in the identification of Toxoplasma gondii as the etiological agent in two patients with recurrent intermediate uveitis (IU). Both patients had recurrent episodes of vitritis (with no focal retinochoroidal lesion) over varying time intervals and were diagnosed to have IU. The tuberculin test was negative in both. Blood counts, erythrocyte sedimentation rate, and serum angiotensin convertase enzyme levels were normal. In both cases, the vitreous fluid tested positive for the T. gondii DNA sequence by using a uveitis DNA chip (XCyton Pvt. Ltd., Bangalore, India). It contained complimentary sequences to “signature genes” of T. gondii, Mycobacterium tuberculosis, M. chelonae, and M. fortuitum. The enzyme-linked immunosorbent assay (ELISA) detected elevated serum antitoxoplasma IgG levels in both. They responded to the antitoxoplasma therapy with oral co-trimoxazole (and additional intravitreal clindamycin in patient 1), with no recurrence during follow-ups of 6 and 8 months, respectively.

Intermediate uveitis.

Intermediate uveitis (IU) is described as inflammation in the anterior vitreous, ciliary body and the peripheral retina. In the Standardization of Uveitis Nomenclature (SUN) working group's international workshop for reporting clinical data the consensus reached was that the term IU should be used for that subset of uveitis where the vitreous is the major site of the inflammation and if there is an associated infection (for example, Lyme disease) or systemic disease (for example, sarcoidosis). The diagnostic term pars planitis should be used only for that subset of IU where there is snow bank or snowball formation occurring in the absence of an associated infection or systemic disease (that is, “idiopathic”). This article discusses the clinical features, etiology, pathogenesis, investigations and treatment of IU.

A Case of Tsutsugamushi Disease Associated With Intermediate Uveitis and Retinal Detachment

PURPOSE: The authors report a Tsutsugamushi patient who has intermediate uveitis and rhegmatogenous retinal detachment without a typical skin eschar, which may be rare. CASE SUMMARY: The authors present a case of a 63-year-old man who complained of fever, chills, and headache, with lymphadenopathy, hepatomegaly, reticulonodular pneumonia, and blurred vision in the right eye after descending a mountain in autumn. Serological findings showed elevated titers for strains of Rickettsia tsutsugamushi, even though no eschar could be found on his body. In addition, the ophthalmologic examination disclosed vitreous opacity as uveitis in his right eye; thus, the patient was treated for Tsutsugamushi disease. However, retinal detachment was found in his right eye even after treatment. Thus, a vitrectomy and intravitreal silicone oil injection was performed, and the patient's best corrected visual acuity improved from hand motion to 0.04 on the 7th day after the operation.

Clinical Characteristics and Treatments of Intermediate Uveitis

PURPOSE: To investigate the clinical characteristics and treatment of intermediate uveitis under new diagnostic standards. METHODS: Medical records of patients diagnosed with pars planitis or intermediate uveitis were followed for more than 6 months, and retrospectively reviewed. RESULTS: A total of 90 patients and 117 eyes were enrolled in the study. The mean age was 40.1 years, and the mean follow-up period was 43.0 months. Thirty percent of cases were bilateral. The most common initial symptom was decreased visual acuity. Snowbank was detected in 39.3%, snowballs in 15.4%, vitritis in 96.6%, and vasculitis in 56.4%. Common complications includedcystoid macular edema (57.3%), cataracts (43.6%), and epiretinal membrane (36.8%). Therapies included topical steroids (82.9% of cases), posterior sub-Tenon steroid injection (45.3% of cases), systemic steroid administration (67.8% of cases), and immunosuppressants (28.7% of cases). Vitrectomy was performed in 11.1% of patients due to complications such as epiretinal membrane and traction retinal detachment. The mean initial and final visual acuities were 0.67 and 0.74, respectively. CONCLUSIONS: The patients in this study experienced various courses of symptoms that required different treatment plans. Future investigations may corroborate these results.

Intermediate uveitis complicated by choroidal granuloma following subretinal neovascular membrane: case reports / Granuloma de coróide secundário a membrana neovascular sub-retiniana em uveíte intermediária: relato de casos

Choroidal neovascularization is a very rare complication in intermediate uveitis. A 27-year-old female patient diagnosed with intermediate uveitis two years ago. She presented with 20/200 visual acuity, snowballs, snowbanks, and macular cystoid edema in the right eye observed by fluorescein and optical coherence tomography (OCT). Photocoagulation was performed in the inferior peripheral retina in both eyes. The patient refused to undergo the prescribed clinical treatment. She returned twelve months later presenting with count fingers visual acuity, dry retina and subretinal macular pigmented granuloma observed on OCT. A 15-year-old female patient with decreased visual acuity of 20/400 in the right eye for eight days. She presented with bilateral vasculitis and papilitis, in the right eye, hemorrhage and extramacular subretinal neovascular membrane were observed on fluorescein and OCT. She was treated with 40 mg prednisone and intravitreous injection of 1.25 mg bevacizumab. Five months later she presented with 20/50 visual acuity, and extramacular granuloma observed on OCT. The formation of subretinal granuloma in intermediate uveitis is a possibility when complicated by subretinal neovascular membrane.

Neovascularização de coróide é uma complicação muito rara na uveíte intermediária(1). Paciente feminino, 27 anos, com diagnóstico de uveíte intermediária dois anos atrás. Apresentava acuidade visual de 20/200, "snowballs", "snowbanks" e edema macular cistóide no olho direito observado na angiofluoresceinografia (AGF) e tomografia de coerência óptica (OCT). Fotocoagulação foi realizada na retina periférica inferior em ambos os olhos. A paciente recusou a submeter-se ao tratamento clínico prescrito. Ela retornou doze meses mais tarde apresentando acuidade visual de conta dedos, retina sem edema e granuloma sub-retiniano macular observado no OCT(2). Paciente feminino, 15 anos, com diminuição da acuidade visual no olho direito (20/400) há oito dias. Apresentava vasculite e papilite em ambos os olhos, no olho direito, hemorragia e membrana neovascular sub-retiniana observada na AGF e OCT. Foi tratada com 40 mg de prednisona e injeção intra-vítreo de bevacizumab (1,25 mg). Cinco meses depois, apresentou acuidade visual de 20/50 e granuloma extramacular observada no OCT. A formação de granuloma sub-retiniano na uveíte intermediária é uma possibilidade quando complicada por membrana neovascular sub-retiniana.

Clinical Analysis of Intermediate Uveitis

PURPOSE: To evaluate the clinical characteristics, recurrence rate and visual prognosis of intermediate uveitis in terms of cryotherapy and pars plana vitrectomy. METHODS: Medical records of 124 eyes in 110 patients who were diagnosed to have intermediate uveitis from Jan. 1988 to Dec. 2000 were retrospectively reviewed. Clinical features, fluorescein angiographic findings in intermediate uveitis, and therapeutic results of vitrectomy and cryotherapy were analyzed. RESULTS: The mean age of the patients was 39.1 years and the mean follow-up period was 3.6 years (2 months ~ 11 years). Of those patients, 12.7% were bilateral and average recurrence rate was 2.9 per year. And 81.5% of the snowbank was located inferiorly. Fluorescein angiography (FAG) was done in 91 eyes. Cystoid macular edema (CME) was observed in 81.3% (74 eyes), focal leakage in 77.6% (69 eyes), and diffuse leakage in 22.5% (20 eyes). In 11 eyes which had undergone pars plana vitrectomy, the recurrence rate decreased from 2.2 a year to 0.6 a year. In 9 eyes which had undergone cryotherapy, it decreased from 3.6 a year to 0.7, which was statistically significant (p<0.05). The visual acuity improved in 34.7% (43 eyes), did not change in 44.4% (55 eyes), and worsened in 21.0% (26 eyes) at the final follow-up. CONCLUSIONS: This demonstrates the overall favorable visual prognosis in patients with intermediate uveitis. Pars plana vitrectomy and cryotherapy may contribute to reducing the recurrence rate of intermediate uveitis.

Clinical Analysis of Pars Planitis with Prominent Snowbank

PURPOSE: To evaluate the clinical characteristics of the intermediate uveitis with prominent snowbank, METHODS: We retrospectively reviewed the records of the patients with intermediate uveitis characterized by the snowbank larger than half a quadrant. RESULTS: Of all 49 patients, 67 eyes, the mean age was 37.3 years. Male patients was 31, and eighteen patients (36.7%) were bilateral. Snowbank was at the inferior in 56 eyes (83.6%), and larger than two quadrant in 16 eyes (23.9%). Mean follow-up was 27 months. Final visual acuity improved in 40 eyes (59.7%), worsened in 4 eyes (6.0%), and more than 0.5 in 51 eyes (76.1%). Complications were cystoid macular edema (23 eyes, 34.3%), retinal detachment (22 eyes, 32.8%), and vitreous hemorrhage (11 eyes, 16.4%). Procedures were barrier laser photocoagulation (45 eyes, 67.2%), pars plana vitrectomy(12 eyes, 17.9%), scleral buckling(2 eyes, 3.0%), cataract surgery (9 eyes, 13.4%), trabeculectomy(6 eyes, 9.6%), and cryopexy (1 eye, 1.5%). Statistically, there was no significant relationship in the final visual acuity and gender, bilaterality, initial visual acuity of 0.5 or above, snowbank larger than two quadrants, and barrier laser photocoagulation. However, pars plana vitrectomy showed a significant relationship (p<0.001). CONCLUSIONS: Intermediate uveitis with prominent snowbank seems to show the similar clinical prognosis to generally-reported intermediate uveitis, and the prognosis of pars plana vitrectomy is good.