Pars-plana vitrectomy in cystoid macular edema associated with intermediate uveitis

Background: Cystoid macular edema (CME) is a common complication in the cou rse of intermediate uveitis. In spite of systemic therapy with steroids or carbonic anhydrase inhibitors, persistence of CME is observed. Pars plana v itrectomy (PPV) is known to influence the course of intermediate uveitis po sitively. The present study was performed to investigate the role of PPV in the therapy of CME in intermediate uveitis. Materials and methods: Forty-t wo eyes of 32 patients were re-examined after PPV for CME. In all eyes fluo rescein angiography was performed. Average age at the time of surgery was 3 1.9 years (range 6-64 years). All patients had received systemic corticoste roid and/or immunosuppressive treatment during the course of their disease. In some patients systemic therapy with carbonic anhydrase inhibitors was p erformed. The mean duration of postoperative follow-up was 20.2 months (ran ge 6-102 months). Results: Preoperative visual acuity (VA) in all eyes was between 1/10 and 0.5. Total regression of CME after surgery was observed in 18 of 42 eyes (42.8%), partial improvement in 7 eyes (16.7%). In 13 of 42 eyes (30.9%) the CME remained unchanged. Twenty-one of 42 eyes (50.0%) expe rienced a postoperative improvement of VA or 2 lines or more. In 18 of 42 e yes (42.8%) there was no change; in 3 eyes (7.2%) VA was less. In the long- term follow-up the corresponding results were slightly worse ( 17/17/8 eyes ) due to secondary complications. In the majority or patients systemic medi cal therapy could be reduced or discontinued. Conclusion: Pars-plana vitrec tomy led to regression of CME in 59% of cases and to subsequent improvement of VA in 50% of eyes with intermediate uveitis. PPV should be considered s oon after medical therapy has been shown to be ineffective.