Management of cataract in uveitis patients

Conway, Mandi D.; Stern, Ethan M; Enfield, David B.; Peyman, Gholam A.

doi:10.1097/icu.0000000000000438

Cited by 16 publications

(6 citation statements)

References 43 publications

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“…[1032] The main concern with cataract surgery in uveitis is the exacerbation of inflammation in the postoperative period that can lead to permanent visual loss. [333435] To prevent and treat postoperative spike in inflammation, perioperative increase in corticosteroids is often advocated. In pediatric eyes with uveitis, the risk of postoperative inflammation is much higher compared to adults, leading to further challenges.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis

Jinagal

Gupta

Agarwal

et al. 2019

Indian J Ophthalmol

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Purpose:To assess the safety and efficacy of intraoperative intravitreal dexamethasone implant in patients of juvenile idiopathic arthritis (JIA)-associated uveitis undergoing phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation.Methods:Retrospectively, data of patients with JIA-associated uveitis undergoing phacoemulsification with PCIOL implantation with intraoperative dexamethasone implant injection were analyzed. Patients with a minimum follow-up of 6 months were included. Primary outcome measures were ocular inflammation, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and worsening of uveitis.Results:8 eyes of 6 patients were included. BCVA was significantly improved at 1, 3, and 6 months postoperatively 0.20 ± 0.09, P = 0.008; 0.18 ± 0.11, P = 0.008; and 0.24 ± 0.11, P = 0.01, respectively. No statistical difference noted in mean IOP at various follow-up visits. None developed worsening of uveitis or Cystoid macular edema.Conclusion:Intraoperative intravitreal dexamethasone implant is a safe and effective in preventing and managing the postoperative inflammation in children with JIA-associated uveitic cataract.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis

Jinagal

Gupta

Agarwal

et al. 2019

Indian J Ophthalmol

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“…Согласно клиническим наблюдениям, ХПУ нередко развивается у пациентов с рассеянным склерозом [10,31,78,82], идиопатическим невритом зрительного нерва, аутоиммунными вос-палительными заболеваниями кишечника, саркоидозом, лимфомой глаз (в качестве маскарадного синдрома) [3,7,11,19,24,28,46,49,65,83,86]. При этом воспаление хориоретинальных структур на крайней периферии глазного дна зачастую предшествует развитию основного заболевания [8].…”

Section: инфекционные и неинфекционные агенты в патогенезе хпуunclassified

“…Например, манифестация неврологических симптомов при рассеянном склерозе происходит в среднем через 8,5 лет после развития ХПУ [7]. В связи с этим многие офтальмологи при обнаружении ХПУ рекомендуют проведение дополнительного обследования для исключения сопутствующей системной патологии [10,78,82].…”

Section: инфекционные и неинфекционные агенты в патогенезе хпуunclassified

Modern etiological and pathogenetic aspects of chronic peripheral uveitis

2022

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Intermediate uveitis is among most severe forms of endogenous uveitis which is more common in young people, being characterized by minimal clinical manifestations at early stages of the disorder. A significant and, sometimes, irreversible decrease in visual acuity is associated with development of long-term complications of chronic cintermediate uveitis (CIU), i.e., complicating cataracts (in up to 57% of the cases), cystic maular edema developing at a frequency of up to 31%), as well as ophthalmic hypertension and glaucoma (up to 16% of the patients). The incidence rate of CIU is 1.5 per 100,000 per year. The eye, despite its high immune privilege, is susceptible to infectious and inflammatory diseases. Clinical and histopathological data suggest autoimmune origin of CIU associated with possible response to some endogenous antigen of unknown origin. The main effectors of inflammation in peripheral chorioretinal structures are CD4+T lymphocytes, which are found in paravasal infiltrates and vitreoretinal exudates in CIU. An important role in CIU pathogenesis is attributed to IL-6 and IL-8, TNFá, vascular endothelial growth factor (VEGF), and micro-RNAs, which show increased expression in most CIU patients. Impaired state of intestinal bacterial microbiome is a potential trigger of intraocular inflammation. Genetic predisposition for CIU was also revealed, due to polymorphisms of human leukocyte antigens and some other genes. It is necessary to expand and deepen our knowledge on the disease pathogenesis, in order to develop effective pharmacological treatment of CIU. The article is review of literature discussing the modern scientific ideas concerning etiology and mechanisms of the CIU development.

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“…Preoperative control of uveitis for at least 3 months is a prerequisite to performing cataract surgery in patients with uveitis [16]. Prompt and appropriate treatment also necessary to visual deterioration in case of postoperative inflammation.…”

Section: Complicationsmentioning

confidence: 99%

Intraoperative intravitreal triamcinolone acetonide injection for prevention of postoperative inflammation and complications after phacoemulsification in patients with uveitic cataract

Ren

Zheng

et al. 2021

BMC Ophthalmol

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Background We aimed to evaluate the efficacy and safety of phacoemulsification with intravitreal 3 mg triamcinolone acetonide injection in preventing postoperative inflammation and complications in patients with non-infectious anterior uveitis and panuveitis complicated cataract. Method In this retrospective cohort study, 140 uveitic cataract patients who received phacoemulsification and intraocular lens implantation in Shanxi Eye hospital from January 2018 to January 2020 were reviewed. The IVTA group (51 eyes of 41 patients) received intravitreal injection of 3 mg triamcinolone acetonide (TA) at the end of surgery, and the control group (51 eyes of 41 patients) without injection matched by propensity score matching were enrolled. Outcome measures were best corrected visual acuity (BCVA), anterior chamber inflammation, intraocular pressure, corneal endothelial cell density, central macular thickness and complications within 3 months follow-up. Results The degree of postoperative anterior chamber inflammation in the IVTA group was lighter than that in the control group (P < 0.05). The postoperative logMAR BCVA of anterior uveitis was better and improved more quickly in the IVTA group(P < 0.05). Postoperative time of using corticosteroids was shorter in the IVTA group as compared to the control group (P < 0.05). The central macular thickness at postoperative month 1 was statistically significantly lower in the IVTA group (P < 0.05). There were no statistically significant differences between the two groups in postoperative corneal endothelial cell density and intraocular pressure (P > 0.05). Two of 51 eyes (3.9%) in the IVTA group and 8 of 51 eyes (15.7%) in the control group had recurrence of uveitis; 6 of 45 eyes (13.3%) in the control group developed cystoid macular edema but none in the IVTA group; 11 of 51 eyes (21.6%) in the IVTA group and 22 of 51 eyes (43.1%) in the control group developed posterior synechiae postoperatively. Conclusions Intraoperative Intravitreal injection of 3 mg TA is an effective and safe adjunctive therapy for preventing postoperative inflammation and complications to promote early recovery for anterior uveitis or panuveitis complicated cataract patients following phacoemulsification. Trial registration This retrospective cohort study was in accordance with the tenets of the Helsinki Declaration and was approved by the Shanxi Eye Hospital Ethics Committee. Written informed consent was obtained from all participants for their clinical records to be used in this study.

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Management of cataract in uveitis patients

Cited by 16 publications

References 43 publications

Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis

Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis

Modern etiological and pathogenetic aspects of chronic peripheral uveitis

Intraoperative intravitreal triamcinolone acetonide injection for prevention of postoperative inflammation and complications after phacoemulsification in patients with uveitic cataract

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