Diagnostic Pars Plana Vitrectomy in Undifferentiated Uveitis: Systematic Review and Meta-Analysis

With advancements in surgical techniques and diagnostic methodologies, this meta-analysis aims to assess the diagnostic yield of pars plana vitrectomy (PPV) in undifferentiated uveitis.

Undifferentiated uveitis poses significant diagnostic challenges in ophthalmology. Although diagnostic PPV has been used to identify underlying etiologies, the diagnostic utility of this procedure is still unclear.

A comprehensive literature search was conducted on March 24, 2025 using PubMed, Embase, and Scopus to identify studies evaluating the diagnostic yield of PPV in undifferentiated uveitis. Studies were included if they evaluated the diagnostic yield of PPV in undifferentiated uveitis and contained various outcome measures: identification rates of infectious and malignant etiologies, confirmation of preoperative suspicion, changes in management, and rates of retinal detachment (RD). A random effects model was used to compute pooled estimates, and heterogeneity was assessed using the I² statistic. The Risk of Bias in Nonrandomized Studies of Interventions, National Institutes of Health Quality Assessment Tool, and Grading of Recommendations, Assessment, Development, and Evaluations were used to assess risk of bias and strength of certainty.

Seventeen studies (1032 eyes) met inclusion criteria. The pooled diagnostic yield of PPV was 45.5% (95% confidence interval [CI]: 37.4%-53.6%), with significant heterogeneity (I² = 84.5%). Subgroup analysis indicated a higher diagnostic yield in studies (10 studies, 521 eyes) performed after 2010 (53.4%) (95% CI: 45.0%-61.6%) compared with those (7 studies, 511 eyes) before 2010 (35.2%) (95% CI: 23.0%-48.3%, P = 0.0217). Infectious etiologies were identified in 60.9% (95% CI: 50.8%-70.5%) of cases, whereas malignant causes accounted for 33.2% (95% CI: 23.6%-44.4%). Preoperative clinical suspicion for infection or malignancy was confirmed in 70.2% (95% CI: 57.1%-82.0%) and 51.7% (95% CI: 34.6%-68.6%) of cases, respectively. Conversely, cases without a clear preoperative suspicion resulted in a diagnostic yield in only 25.2% (95% CI: 12.8%-39.7%). A change in management was observed in 21.6% (95% CI: 12.6%-32.1%) of cases after PPV. Postoperative RD occurred in 3.9% (95% CI: 1.5%-7.1%) of eyes. Using GRADE tool, 2 outcomes were graded low and 4 were graded very low because of the retrospective nature of all studies included.

Diagnostic PPV may serve as a useful adjunct in the evaluation of undifferentiated uveitis; however, its diagnostic yield is greater when guided by a specific preoperative diagnostic hypothesis, particularly for suspected infectious or malignant etiologies.

The authors have no proprietary or commercial interest in any materials discussed in this article.