Invasive diagnostic techniques for uveitis and simulating conditions

Many patients with uveitis have such characteristic ocular signs and symptoms, associated systemic disorders, and laboratory abnormalities that a satisfactory clinical diagnosis can be established without the need for invasive intraocular studies. Most other patients with uveitis have mild, self-limited and/or readily controllable disease that does not warrant aggressive invasive testing. In contrast, some patients with uveitis have atypical ophthalmic and/or systemic features or do not respond to conventional antiinflammatory therapies. Such patients may be candidates for invasive diagnostic testing. In this paper, the author describes the techniques of aqueous aspiration, vitreous aspiration, diagnostic vitrectomy, fine-needle aspiration biopsy, controlled aspiration of subretinal fluid, incisional chorio-retinal biopsy and diagnostic enucleation employed in selected patients with uveitis or a simulating condition. The author stresses the potential risks as well as benefits of the different invasive diagnostic techniques and emphasizes the limited indications for these procedures.