Vision Vitrectomy

Intermediate uveitis may not warrant any therapeutic intervention in mild cases where the visual acuity is 20/40 or better. However, medical therapy is required for most patients. Macular edema is a frequent complication and requires prompt management to prevent permanent vision loss. In general, topical steroids are minimally effective in intermediate uveitis, except in those patients who are aphakic. Periocular and systemic steroids are substantially more efficacious. Periocular steroid injections are preferable in unilateral presentations and in children, whereas oral or other systemic routes are required for bilateral cases. For steroid-resistant intermediate uveitis, immunosuppressive therapy or surgery (cryotherapy and vitrectomy) may be necessary. Complications associated with intermediate uveitis include persistent CME,... 

Intravitreal injections of antibiotics (which do not easily penetrate the eye by any other route) are the cornerstone of the management of endophthalmitis although adjunctive treatments, such as IV antibiotics and early vitrectomy have often been employed. A recent multicenter study on postoperative endophthalmitis found that IV antibiotics had no significant effect on clinical outcomes while early vitrectomy was beneficial only in eyes with light perception or worse. In eyes with better vision, early vitrectomy offered no significant benefit (see Chapter 6). The role of IV antibiotics in other causes of endophthalmitis such as trauma was not established in this study (108). An ideal antibiotic for intravitreal use would have a long half-life in the... 

In view of successful animal experiments (20 see also Chapter 14), a sustained-release dexamethasone device was implanted in one eye of a patient with bilateral severe uveitis associated with multiple sclerosis (20,21). The patient had previously undergone pars plana lensectomy and vitrectomy in the right eye for decreased vision associated with cataract. Despite chronic topical corticosteroids, the patient had persistent bilateral low-grade inflammation and recurrent severe bilateral iridocyclitis. Best corrected visual acuity was 20/400 in both eyes. Systemic corticosteroids and methotrexate controlled the intraocular inflammation but the patient was intolerant of these medications because of systemic side effects. The nondegradable dexamethasone device was inserted into the patient s left eye. 

---