Cataract surgery in the setting of uveitis

Gelder, Russell N. Van; Leveque, Thellea K.

doi:10.1097/icu.0b013e32831b9b22

Cited by 57 publications

(46 citation statements)

References 28 publications

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“…Recent literature reports excellent outcomes, following placement of IOLs in uveitis. [234567] Several recent studies suggest that the incidence of postoperative complications may be lower in eyes receiving acrylic IOLs compared with other materials. [4] However, postoperative complication rates remain higher in the uveitic population.…”

Section: Discussionmentioning

confidence: 99%

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Late dislocation of in-the-bag intraocular lenses in uveitic eyes: An analysis of management and complications

Ganesh

Sen

Sharma

2017

Indian J Ophthalmol

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Aim:An analysis of late in-the-bag dislocation of intraocular lenses (IOL), in uveitic eyes.Setting:Referral uveitis clinic.Design:Retrospective case series.Materials and Methods:All case records of eyes with chronic uveitis that had phacoemulsification with IOL implantation, at a referral uveitis clinic between February 1997 and January 2015 were retrieved and analyzed. Only those eyes with no documented intraoperative complication and no predisposing risks to IOL dislocation, such as pseudoexfoliation, high myopia, trauma, and prior VR surgery were included in this study.Results:A total of 581 eyes with chronic uveitis underwent phacoemulsification with IOL implantation under steroid cover from February 1997 to December 2015. Out of these 581 eyes, 10 patients (11 eyes) had experienced late in-the-bag IOL dislocation (1.89%). All 11 eyes had chronic intermediate uveitis. The mean duration from the time of cataract surgery to IOL dislocation was 11.24 years. 5 out of 11 eyes had pars plana vitrectomy (PPV) with IOL removal with 4-point sutured scleral fixated IOL. Two out of 11 eyes had PPV with in-the-bag IOL re-fixation. Out of 11, 2 eyes had PPV with IOL removal only. Remaining 2 eyes of 2 patients did not opt for surgery. Out of 11, 8 eyes had improved vision at last follow-up.Conclusions:In-the-bag dislocation of IOL is a rare late complication in uveitic eyes. With tight perioperative inflammatory control, scleral-fixated posterior chamber intraocular lens or IOL re-fixation are good options of restoring vision in these high-risk eyes.

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Section: Discussionmentioning

confidence: 99%

“…Several studies in the recent past report excellent surgical outcomes following cataract surgery in uveitis with strict perioperative control of inflammation, appropriate surgical technique, improved IOL design, and material and in-the-bag placement of IOL. [1234567]…”

mentioning

confidence: 99%

Late dislocation of in-the-bag intraocular lenses in uveitic eyes: An analysis of management and complications

Ganesh

Sen

Sharma

2017

Indian J Ophthalmol

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“…Although good visual outcome is often obtained with phacoemulsification and posterior chamber intraocular lens (IOL) implantation [1,2], the absence of inflammation before and after surgery is critical for the achievement of a good visual outcome [3][4][5][6]. Cataract extraction in patients with noninfectious uveitis requires thoughtful planning of the perioperative anti-inflammatory regimen.…”

Section: Introductionmentioning

confidence: 99%

Comparison of orbital floor triamcinolone acetonide and oral prednisolone for cataract surgery management in patients with non-infectious uveitis

Roesel

Heinz

Koch

et al. 2010

Graefes Arch Clin Exp Ophthalmol

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“…Since the 1990s, a great deal of discussion has centered on the surgical correction of cataracts in people with uveitis including indications and timing of surgery, optimal surgical technique, and pre- and postoperative surgical treatment for cataract extraction (Alió 1999; Dunn 2009; Foster 1992; Okhravi 1999; Van Gelder 2009). In the early 2000s, phacoemulsification with in-the-bag IOL implantation emerged as a preferred surgical procedure for most people with uveitis with cataract (Alió 2002).…”

Section: Introductionmentioning

confidence: 99%

Types of intraocular lenses for cataract surgery in eyes with uveitis

Leung

Lindsley

Kuo

2014

Cochrane Database of Systematic Reviews

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Background Cataract formation often occurs in people with uveitis. It is unclear which intraocular lens (IOL) type is optimal for use in cataract surgery for eyes with uveitis. Objectives To summarize the effects of different IOLs on visual acuity, other visual outcomes, and quality of life in people with uveitis. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2013), EMBASE (January 1980 to August 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to August 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 14 August 2013. We also performed forward and backward searching using the Science Citation Index and the reference lists of the included studies, respectively, in August 2013. Selection criteria We included randomized controlled trials (RCTs) comparing hydrophobic or hydrophilic acrylic, silicone, or poly(methyl methacrylate) (PMMA) IOLs with or without heparin-surface modification (HSM), with each other, or with no treatment in adults with uveitis, for any indication, undergoing cataract surgery. Data collection and analysis We used standard methodological procedures expected by The Cochrane Collaboration. Two review authors screened the search results and for included studies, assessed the risk of bias and extracted data independently. We contacted study investigators for additional information. We did not perform a meta-analysis due to variability in reporting and follow-up intervals for the primary and secondary outcomes of interest. Main results We included four RCTs involving 216 participants (range of 2 to 140 participants with uveitic cataract per trial) and comparing up to four types of IOLs. The largest study was an international study with centers in Brazil, Egypt, Finland, France, Japan, the Netherlands, Slovak Republic, Spain, and the USA; two studies were conducted in Germany and one in Saudi Arabia. There was substantial heterogeneity with respect to the ages of participants and etiologies of uveitis within and across studies. The length of follow-up among the studies ranged from 1 to 24 months after cataract surgery. The studies were at low risk of selection bias, but two of the four studies did not employ masking and only one study included all randomized participants in the final analyses. The funding source was disclosed by investigators of the largest study (professional society) and not reported by the other three. Due to heterogeneity in lens types evaluated and outcomes reported among the trials, we did not combine d...

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Cataract surgery in the setting of uveitis

Abstract: Provided the unique challenges of cataract surgery in the setting of uveitis are recognized and appropriately addressed, excellent visual outcomes can be achieved in most patients.

Cited by 57 publications

References 28 publications

Late dislocation of in-the-bag intraocular lenses in uveitic eyes: An analysis of management and complications

Late dislocation of in-the-bag intraocular lenses in uveitic eyes: An analysis of management and complications

Comparison of orbital floor triamcinolone acetonide and oral prednisolone for cataract surgery management in patients with non-infectious uveitis

Types of intraocular lenses for cataract surgery in eyes with uveitis

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