PPV 清除了玻璃体腔内的炎性介质[27]，减轻了它们对黄斑部视网膜的损害，同时解除了玻璃体对黄斑部视网膜的牵引，从而可以在很大程度上减轻黄斑囊样水肿。
8.影响预后的因素
最后的视力与术前复发的频率或病程没有明显的相关性，但术前炎症活动较严重者术后视力提高的效果较差[29]。年龄、性别、病程、对激素治疗的反应、青光眼、低眼压，玻璃体出血对手术的预后没有明显的影响[22,27]。而新生血管增生，黄斑裂孔、黄斑囊样水肿，术前的活动性炎症可以影响手术的预后，尤其玻璃体基底部活跃的新生血管与术后并发症密切相关。
9.有待解决的问题
PPV治疗葡萄膜炎以来，已有不少的相关的对于临床治疗效果的比较乐观的报道，但仍有许多问题有待解决。由于多种因素的影响，以及多数葡萄膜炎本身的慢性进展的特点，很难对术前和术后的病程做出一个确切的比较。所以还需要一些多中心，更多病例和更长期随访时间的研究。由于PPV的术后并发症的发生率比较低，而术后有的患者可望药物减量或停药，是否可以考虑早期手术。PPV治疗葡萄膜炎，除了清除间质的混浊和明确诊断的需要外，其它的适应征还有待进一步明确。
   
参考文献：
1．Yusuf Ozerturk,Yavuz Bardak and Mustafa Durmus.Vitreoretinal surgery in Behcet’s disease with severe ocular complications. Acta Ophthalmol Scand 2001 Apr; 79 (2):192-6
2.Foster CS.Vitrectomy in the management of uveitis.Ophthalmology 1988; 95:1011-2
3.Foster CS,Fong LP,Singh G. Cataract surgery and intraocular lens implantation in patients with uveitis. Ophthalmology 1989；96:281-8
4.Ozyazgan Y,Yurdakul S,Yazici H et al. Low dose cyclosporin A versus pulsed cyclophosphamide in Behcet’s syndrome:a single masked trial.Br J Ophthalmol  1992 Apr;76(4):241-3.
5.Yazici H, Ozyazgan Y. Medical management of Behcet’s syndrome. Dev Ophthalmol 1999；31:118-131
6．Burkhard Wiechens,Bernhard Nolle,Han A.Reichelt.Pars-plana vitrectomy in cystoid macular edema associated with intermediate uveitis.Graefe’s Arch Clin Exp Ophthalmol 2001;239:474-81
7.Foster DJ,Rao NA,Smith RE.Corticosteroids in the treatment of intermediate uveitis.Dev Ophthalmol 1992;23：63-170
8.Mieler WE.Aaberg TM. Vitreous surgery in the management of peripheral uveitis .Dev Ophthalmol 1992;23:239-50    
9.Flach AJ. Acetazolamide treatment of CME in patients with uveitis. (letter ) Ophthalmology 1996; 103:1715-1716
10.Peterson M,Yoshizumi MO,Hepler R,Mondino B,Kreiger .A Topical indomethacin in the treatment of chronic cystoid macular edema.Graefe’s Arch Clin Exp Ophtalmol 1992;230:401-5
11.Thach AB,Dugel PU,Flindall RJ,et al. A comparison of retrobulbar versus sub-Tenon’s corticosteroid therapy for cystoid macular edema refractory to topical medications .Ophthalmology 1997;104:2003-8 
12.Bwlfort R,Toledo de Abreu M,Petrilli AM,et al.Cytotoxic drug in intermediate uveitis.Dev Ophthalmol 1992;23:219-225
13．Cox SN,Hay E,Bird AC Treatment of chronic macular edema with acetazolamixe .Arch Ophthalmol 1988;106:1190-1185
14.Farber MD,Lam S,Tessler HH,et al. Reduction of macular edema by acetazolamide in patients with chronic iridocyclitis: a randomized prospective crossover study.Br J Ophthalmol 1994; 78:4-7
15.Whitcup SM,Csaky KG,Podgor MJ, et al. A randomized,masked,crossover trial of acetazolamide for cystoid macular edema in patients with uveitis.Ophthalmology 1996;103:1054-1063
16． Bacskulin A,Eckardt C .Results of pars plana vitrectomy in chronic uveitis in childhood.Ophthalmologe 1993;90:434-9
17.Eckardt C,Bacskulin A .Vitrectomy in intermediate uveitis.Dev Ophthalmol 1992;23:232-8
18.Heiligenhars A,Bornfeld N,WessingA .Long-term results of pars plana vitrectomy in the management of intermediate uveitis.Curr Opin Ophthalmol 1996;23:195-203
19．Hopital Ophtalmique, Jules Gonin.Vitrectomy in the management of uveitis .Ocular Immunology and Inflammation 2000;8(4):285-91
20．Panagiota Stavrou ,Stefanos Baltatzis,Erik Letko. Pars plana vitrectomy in patients with intermediate uveitis .Ocular Immunology and Inflammation  2001;9(3):141-51
21.Kaplan HJ.Surgical treatment of intermediate uveitis,Dev Ophthalmol 1992；23:185-9
22．Mieler WF,Will BR,Lewis H,Aaberg TM.Vitrectomy in the management of peripheral uveitis.Ophthalmology.1988;95:859-64
23.Algvere P,Alanko H,Dickhoff K,et al. Pars plana vitrectomy in the management of intreaocular inflammation.Acta Ophthalmol.1981;59:727-36
24.Michelson JB, Friedlaender MH, Nozik RA. Lens implant surgery in pars planitis. Ophthalmology 1999;97:1023-6
25.Foster CS,Stavrou P,Zafirakis P,et al.Intraoclar lens explantation from patients with uveitis.Am J Ophthalmol.1999;128:31-7
26.Pravin U,Dugel,Narsing A,Rao,Werdar Ozler, et al.Pars Plana Vitrectomy for Intraocular Inflammation related Cystoid Macular Edema Unresponsive to Corticosteroids.Ophthalmology 1992;99(10):1535-41
27.Diamond JG,Kaplan HJ.Lensectomy and vitrectomy for complicated cataract secondary to uveitis.Arch Ophthalmol 1978;96:1798-804
28.Brinkman CJ,Otto AJ, Breebaart AC.Ocular inflammatory activity following different techniques of lens extraction and vitrectomy in rabbits.Curr Eye Res 1990;9:1137-40
29.Arnd Heiligenhaus,Norbert Bornfeld,Michael H Foerster, et al. Long term result of pars plana vitrectomy in the management of complicated uveitis . British J Ophthalmol 1994;78:549-554
30.G.W.Aylward.The place of vitreoretinal surgery in the treatment of macular edema .Documenta Ophthalmologia 1999;97:433-8
31.Daniel Vaughan,Taylor Asbury,Paul Riordan-Eva.General Ophthalmology Appleton & Lance,fifteenth edition:142-58
32.何守志主编，临床眼科学　天津科学技术出版社　2001，1,P564-80　

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