Abstract：Objective: To investigate the clinical outcome of combined anterior and posterior segment surgery in the treatment of patients with refractory uveitis with posterior segment tissue involvement. Methods: The retrospective case series of 33 patients (33 eyes) with refractory uveitis and cataract who underwentcombined posterior and anterior approaches in Beijing Chaoyang Hospital from May 2018 to January 2021 were reviewed. According to the etiology, 16 infectious uveitis patients (16 eyes, infectious group) were included, consisting of 4 eyes of cytomegalovirus chororetinitis, 3 eyes of herpetic uveitis, 2 eyes of toxocariasis, 1 eye of acute retinal necrosis and 6 eyes of bacterial or fungal endophthalmitis. Seventeen non-infectious uveitis patients (17 eyes, non-infectious group) were also included, consisting of 12 eyes of idiopathic uveitis, 1 eye of lymphoma, 2 eyes of heterochromic iridocyclitis and 2 eyes of juvenile idiopathic arthritis uvitis. Wilcoxon signed rank test was used to analyze the preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure and aqueous humor flare index of all patients. The number and percentage of cases were used to show the intraoperative implantation of lens and silicone oil in the infectious uveitis group and non-infectious uveitis group of these patients and compared by the Chi-square test. Results: Preoperative and postoperative logMAR BCVA of all patients were 2.40 (1.50, 2.70) and 1.70 (0.55, 2.70) respectively, and the difference was statistically significant (Z=-2.61, P=0.009). The postoperative BCVA of non-infectious uveitis group was 0.92 (0.40, 1.70), which was significantly lower than that in the infectious uveitis group that was 2.25 (2.10, 2.93) (Z=-2.97, P=0.003). The proportion of BCVA improvement of the two groups were 44% and 71% respectively. The preoperative and postoperative intraocular pressure of all patients was 15.0 (10.0, 18.5) mmHg (1 mmHg=0.133 kPa) and 14.0 (12.0, 16.00) mmHg respectively. There is no statistically significant difference between them (Z=-0.02, P=0.983). Preoperative and postoperative aqueous humor flare index were 12.4 (7.5, 73.2) pc/ms and 5.0 (3.3, 7.3) pc/ms respectively.The operation significantly decreased aqueous humor flare index (Z=-2.99, P=0.003). The ratio of intraocular lens implantation cases in infectious uveitis group was significantly lower than that in non-infectious uveitis group (x2 =6.94, P=0.008). But the ratio of silicone oil filling between the two groups was no significantly difference (x2=0.25, P=0.619). Conclusion: Combined anterior and posterior segment surgery could improve visual acuity and reduce aqueous humor flare index, and control inflammation reaction in patients with refractory uveitis with posterior segment tissue involvement.
张涛,周强,刘旭辉,等. 前后节联合手术治疗复杂性葡萄膜炎的临床疗效[J]. 中华眼视光学与视觉科学杂志, 2022, 24(11): 842-848.
Tao Zhang, Qiang Zhou, Xuhui Liu,et al. Clinical Efficacy of Anterior and Posterior Segment Combined Surgery in the Treatment of Complex Uveitis Patients. Chinese Journal of Optometry Ophthalmology and Visual science, 2022, 24(11): 842-848. DOI: 10.3760/cma.j.cn115909-20211210-00483
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