Analysis of clinical features and visual outcomes of pars planitis.

PURPOSE: To evaluate the demographic characteristics, clinical features, treatment and outcomes of patients with pars planitis in a tertiary referral center in Turkey. METHODS: Medical records of patients with pars planitis were retrospectively reviewed. The data including demographic and ocular features and treatment outcomes were recorded. The distribution of clinical findings and complications were evaluated according to age and gender groups. The changes in final BCVA compared to the initial BCVA were noted. Statistical analysis was performed using SPSS software (Version 18.0, SPSS Inc., Chicago, USA). RESULTS: Twenty-seven patients (54 eyes) were included in this study. 16 patients were male (59.3%), and 11 were female (40.7%). Mean age at diagnosis was 12.84 ± 8.26 (range 4-36) years. Mean follow-up period was 61.3 ± 52.15 (range 9-172) months. Mean BCVA was 0.58 ± 0.36 (range 0.03-1.00) (0.40 ± 0.45 logMAR) at presentation, and 0.81 ± 0.28 (range 0.10-1.00) (0.14 ± 0.27 logMAR) at final visit (P = 0.001). Vitreous inflammation (100%), vitreous haze (92.6%), snowballs (74.1%), snowbanks (66.7%), anterior chamber cells (66.7%) and peripheral retinal vascular sheathing (48.1%) were the most common presentations. Ocular complications included vitreous condensation (51.9%), cystoid macular edema (22.2%), cataract (18.5%), inferior peripheral retinal detachment (11.1%), glaucoma (5.6%) and vitreous hemorrhage (3.7%). Treatments included topical, periocular, intravitreal and systemic corticosteroids, immunosuppressives, peripheral laser photocoagulation and pars plana vitrectomy when needed. CONCLUSIONS: Pars planitis is an idiopathic chronic intermediate uveitis mostly affecting children and adolescents. In spite of its chronic nature with high potential of causing ocular complications, adequate treatment and close follow-up lead to favorable visual outcomes.

[Association of epiretinal membranes with macular edema in pars planitis]. / Asociación de membranas epirretinianas con edema macular en pars planitis.

INTRODUCTION: Pars planitis (PP) is a form of intermediate uveitis that manifests with several posterior segment complications, including cystoid macular edema (CME) and epiretinal membrane formation (ERM). On the presence of CME the patient is usually treated with anti-inflammatory and/or immunosuppressive drugs. However the presence of CME may coexist with ERM formation, and therefore the treatment could be different. PURPOSE: To determine the association between ERM and CME in PP. MATERIALS AND METHODS: Case control series. The charts of patients diagnosed with PP were retrospectively reviewed. All patients had fluorescein angiogram (FA) and spectral domain optical coherence tomography (SD-OCT). Presence of ERM was determined by SD-OCT, while CME was determined by FA. Contingency tables were used to determine the risk of developing CME with ERM. RESULTS: 31 eyes presented ERM. 16 eyes presented CME. Relative risk to have CME and ERM was 0.971, with a P value of 0.77 (χ(2)). CONCLUSIONS: There is no association between ERM formation and the development of CME. There is no evidence to suggest a surgical approach as first line of treatment with the presence of ERM in PP.

Pars plana vitrectomy and internal limiting membrane peeling for macular oedema secondary to retinal vein occlusion: a pilot study.

INTRODUCTION: Macular oedema is the main cause of visual impairment following retinal vein occlusion. The purpose of this study was to evaluate the anatomical and functional outcome of pars plana vitrectomy and internal limited membrane (ILM) peeling for macular oedema secondary to retinal vein occlusion. CLINICAL PICTURE: This pilot study is a prospective nonrandomised series of 11 eyes of 11 patients with macular oedema secondary to retinal vein occlusion. The best-corrected visual acuity (BCVA), foveal thickness on optical coherence tomography, fundus fluorescein angiography (FFA) and multifocal electroretinography were evaluated. TREATMENT AND OUTCOME: All 11 patients underwent pars plana vitrectomy with ILM peeling. The mean postoperative follow-up was 13.5 months (range, 1.5 to 24). The mean thickness at the foveal centre decreased from 794 +/- 276 microm preoperatively to 373 +/- 150 microm, 302 +/- 119 microm, 249 +/- 203 microm and 185 +/- 66 microm at 1 week, 1 month, 3 months and the final visit postoperatively, respectively (all P <0.001, paired t- test, compared to preoperative thickness). Postoperative FFA demonstrated markedly reduced leakage in the macular region. At the final visit, BCVA improved 2 lines or more in 72.7% (8/11) of patients and was unchanged in 27.3% (3/11) patients. Complications included cataract in 7 patients and vitreous haemorrhage, recurrence of macular oedema and visual field defect in 1 case each. CONCLUSION: Pars plana vitrectomy and ILM peeling rapidly reduced the macular oedema caused by retinal vein occlusion, with improvement in BCVA.

Grading of pars planitis by ultrasound biomicroscopy--echographic and clinical study.

OBJECTIVE: To determine the value of high frequency ultrasound biomicroscopy (UBM) in the assessment of pars planitis, and in particular to correlate UBM findings and ophthalmoscopy findings. METHODS: All patients with pars planitis were identified from the uveitis database of the Department of Ophthalmology, University of Aberdeen. Fifteen consecutive patients (age 14-52 years) underwent complete ophthalmological examination. UBM was performed at a sound frequency of 50 MHz on 17 eyes of 10 patients to determine the extent of disease. UBM findings were evaluated by two investigators in a blinded fashion and graded from 0 to 3 according to the following grading criteria: 0=no cells, 1=mild cells, 2=marked cells, 3=organization of cells. Opthalmoscopy findings were also graded using the same criteria. UBM and ophthalmoscopy findings were independently graded and compared. RESULTS: We found a good inter-observer correlation for the UBM grading of pars planitis (rho=0.86). There was no significant difference in the grading of pars planitis by indirect ophthalmoscopy as compared to grading by UBM (P>0.05). CONCLUSION: UBM appears to be a valuable and reliable diagnostic technique for the evaluation of patients with pars planitis and may be useful especially in patients with media opacities to diagnose and/or monitor efficacy of treatment.

An immunohistochemical study of the 'snowbank' in a case of pars planiti.

PURPOSE: To characterize the extracellular matrix and cellular components of a 'snowbank' removed during vitreous surgery for treatment of retinal detachment complicating pars planitis. METHODS: The 'snowbank' was examined using immunohistochemical techniques and a panel of monoclonal and polyclonal antibodies directed against glial fibrillary acidic protein (GFAP), cytokeratin, alpha smooth muscle actin, tenascin, laminin, fibronectin, and collagen types I, II, and III. RESULTS: The 'snowbank' was acellular except on the uveal side where there were cytokeratin-positive retinal pigment epithelial cells. There were no cells positive for the glial cell marker GFAP and the myofibroblast cell marker alpha smooth muscle actin. The extracellular matrix of the 'snowbank' contained tenascin and collagen types I, II, and III. There was no immunoreactivity for laminin and fibronectin. CONCLUSION: These results on the immunohistochemical components of the 'snowbank' may be useful in clarifying the nature of the chronic inflammatory process in pars planitis. They indicate extensive tissue repair and remodeling, leading to major loss of function.

Ultrasound biomicroscopic imaging in intermediate uveitis.

BACKGROUND: Clinical examination of the region of the eye mainly affected in patients with intermediate uveitis is difficult and often hampered by media opacities. In that perspective ultrasound biomicroscopy (UBM) promises to be a valuable additional diagnostic tool. METHODS: UBM was performed at a sound frequency of 50 MHz on 26 eyes of 13 patients with intermediate uveitis in order to determine configuration of pars plana, peripheral retina, and vitreous. Findings of ophthalmoscopy with scleral indentation and UBM were compared. RESULTS: In 18 of 26 eyes pathological structures such as membraneous or fluffy vitreous condensations were identified by UBM. Among these UBM revealed pathological findings which were not visible on funduscopy in nine eyes. Most importantly, vitreoretinal adhesions with traction on the retina were imaged in four eyes. However, in three eyes vitreous opacities being visible on funduscopy were not identified by UBM. CONCLUSION: UBM seems to be a valuable diagnostic technique for the evaluation of patients with intermediate uveitis. Longitudinal studies will have to determine the relevance of UBM findings for the individual clinical course and their influence on therapeutic decisions.

Vitrectomia em pacientes com pars planitis e edema cístico macular: quando indicá-la / Vitrectomy in cystoid macular edema due to prs planitis

O edema cístico macular é uma das complicaçöes mais temíveis da pars planite, frequentemente responsável por severo e definitivo déficit visual. A importância da vitrectomia no tratamento de muitas uveítes crônicas tem sido amplamente demonstrada. Já a sua eficácia na regressäo do edema cístico macular é um assunto mais recente e polêmico. Trata-se do primeiro estudo realizado no Brasil sobre a eficácia da vitrectomia no controle do edema cístico macular associado à pars planits. Sete pacientes com edema cístico macular crônico, rebelde a todas as tentativas terapêuticas, foram submetidos à vitrectomia via pars plana e observados, sequencialmente, por no mínimo 20 e no máximo 74 meses. O edema cístico macular foi responsável pela decesäo cirúrgica. A literatura foi revisada e discutida

A fluorescein angiographic study of patients with pars planitis and peripheral exudation (snowbanking) before and after cryopexy.

BACKGROUND: Transconjunctival cryopexy of the vitreous base is clinically effective in patients with steroid nonresponsive pars planitis who have peripheral neovascularization. Cryoablation of the region previously has been thought to eliminate the areas of permeable neovascular tissue, thus removing the focus of exudation. The authors report the first study of patients with refractory pars planitis in which fluorescein angiography of the inferior pars plana snowbanks was performed both before and after cryopexy of the vitreous base. METHODS: Twelve consecutive phakic eyes with pars planitis and prominent peripheral snowbanks had fluorescein angiograms of the pars plana. Clinical involvement was graded on the basis of visual acuity, levels of vitreous inflammation and cystoid macular edema, and on the extent of peripheral snowbanking. Transconjunctival cryopexy of the vitreous base was performed. Fluorescein angiography of the pars plana snowbanks was repeated 2 months after the procedure, and clinical involvement again was graded. RESULTS: Early hyperfluorescence with late leakage was present in all eyes and was limited to the area of the pars plana snowbanks. After cryopexy of the vitreous base, all eyes demonstrated hypofluorescence and diminution of late-phase dye leakage in the treated areas. Eighty-three percent of all eyes demonstrated clinical improvement, consistent with previously reported studies. CONCLUSION: Cryopexy of the vitreous base decreases peripheral exudation in patients with refractory pars planitis and snowbanking. This suggests that elimination of peripheral neovascular tissue may be directly related to clinical improvement in these patients.

Serum levels of interleukin-2 receptor in ocular Behçet's disease.

Serum interleukin-2 receptor levels were evaluated in 69 patients who had chronic bilateral uveitis and in 22 control subjects. Fifty-one of the 69 patients with uveitis had the ocular type of Behçet's disease and 18 had pars planitis (intermediate uveitis). The mean serum interleukin-2 receptor level was 412.6 +/- 94.6 U/ml for the control group, 465.0 +/- 96.6 U/ml for the patients with intermediate uveitis, and 810.9 +/- 369.3 U/ml for those with ocular Behçet's disease. The serum interleukin-2 receptor levels of patients with ocular Behçet's disease were significantly different from the levels of both the control and the intermediate uveitis groups (P < .001). The differences in serum levels of patients with intermediate uveitis and the levels of the control subjects were not statistically significant. Treatment of patients with ocular Behçet's disease for four to six weeks with either cyclosporine, methylprednisolone, or a combination of both, decreased the intraocular inflammation in nearly all cases. The influence of treatment on the level of serum interleukin-2 receptor, however, was variable.

Immune mechanisms in choroido-retinal inflammation in man.

The immunohistopathological findings of enucleated eyes and immunological abnormalities in several clinical disorders which result in intraocular inflammation are presented. With current immunological techniques, it is possible to define the type and activation status of the cells infiltrating the tissues. In all eyes examined, the predominant cell type was of activated CD4+ T-cells suggesting that the mechanisms involved in the perpetuation of the inflammatory response are similar and it is the initiating events which are likely to determine the site of pathology. The effects of activated CD4+ T-cells and the lymphokines they secrete in the chronic inflammatory process in the ocular tissues are discussed.