Pilot study: Vitrectomy more effective than medication in uveitic CME

Pars plana vitrectomy improved visual acuity significantly better than systemic medication in a small study of patients with cystoid macular edema due to chronic uveitis, a prospective pilot study found.

David Charteris, MD, and colleagues at Moorfields Eye Hospital in London compared surgical and medical therapies in 23 eyes of 23 patients with cystoid macula edema (CME) secondary to chronic uveitis. The researchers randomly assigned 11 patients to undergo pars plana vitrectomy and 12 patients to receive systemic corticosteroid and/or immunosuppressive medications.

At 6 months' follow-up, mean visual acuity improved significantly in patients undergoing vitrectomy, from 1.0 preoperatively to to 0.55 on the logMAR acuity scale (P = .011). Five of the 11 vitrectomy-treated eyes (42%) achieved 20/40 or better vision. In contrast, vision improved only by 0.03 in patients treated with steroids and/or immunosuppressants, according to the study authors.

Four vitrectomy-treated eyes (33%) showed angiographic improvement, one eye showed deterioration and seven eyes remained unchanged. In the medically treated group, fluorescein leakage decreased in one eye, deteriorated in two eyes and remained unchanged in four eyes, according to the study.

The findings justify a large-scale study of pars plana vitrectomy as a treatment for CME, the authors said.

The study is published in the September issue of the British Journal of Ophthalmology.