%0 Journal Article
%T Vitreous Analysis in the Management of Uveitis
%A Erika M. Damato
%A Martina Angi
%A Mario R. Romano
%A Francesco Semeraro
%A Ciro Costagliola
%J Mediators of Inflammation
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/863418
%X A correct diagnosis of uveitis is often challenging, given the wide range of possible underlying conditions and the lack of typical phenotypes. Management decisions may be difficult in view of the risk of visual loss with either inappropriate or delayed therapy. Analysis of the vitreous may therefore be used to provide the clinician with valuable information. In this paper, we describe the main clinical situations in which vitreous sampling is indicated and provide some guidance to clinicians for tailoring their requests. These situations include suspected intraocular infection and suspected intraocular malignancy. We describe the principal tests carried out on vitreous samples, including cultures, polymerase chain reaction-based testing, and cytokine analysis. Limitations of the tests used are likely to become less as more advanced testing methods are introduced. The importance of selecting the appropriate investigations to support a clinical suspicion is emphasised, as is the interpretation of test results within a clinical context. 1. Introduction The term ¡°uveitis¡± encompasses a wide spectrum of conditions resulting in intraocular inflammation. Standardised uveitis nomenclature (SUN) defines uveitis depending on the predominant site of inflammation within the eye [1]. At the most severe end of the spectrum, uncontrolled or inadequately treated posterior uveitis may result in irreversible visual loss. Uveitis may be associated with an underlying systemic disease or may exclusively involve the eye [2]. There are a vast number of causes and conditions related to the development of uveitis; however, these may be broadly divided into infectious, autoinflammatory, and neoplastic causes. Extensive investigations are often carried out to establish one, as the clinical phenotype may not be specific for a diagnosis. Common investigations include angiography, blood tests, urinalysis, chest X-rays, and CT scans. In certain situations, incorrect treatment may be catastrophic for vision and could potentially threaten the patient¡¯s life [3]. Hence, a rapid and accurate diagnosis based on intraocular sampling may be essential, mainly to exclude infection or malignancy before the introduction of powerful immunosuppressive or steroid therapy. The vitreous gel is amenable to sampling, either by vitreous tap, where a small amount of gel is aspirated with a needle or by a formal vitrectomy, where most or all of the vitreous gel is removed surgically [4]. In this paper, we describe the clinical situations in which vitreous sampling may become necessary, providing a guide
%U http://www.hindawi.com/journals/mi/2012/863418/