Outcome of phacoemulsification in patients with uveitis

Abstract

Aims: To examine the visual outcome and identify risk factors for postoperative uveitis, macular oedema and neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy after phacoemulsification and intraocular lens (IOL) implantation in patients with uveitis. Method: This is a retrospective review of the medical records of 101 eyes of 101 patients. One eye was randomly selected for inclusion in patients who had bilateral surgery. Patients with juvenile arthritis, keratouveitis and lymphoma-associated uveitis were excluded. Results: At the first postoperative and final visits, visual acuity was significantly better (p,0.001), and 64.4% and 71.3% of patients, respectively, had achieved >2 Snellen's lines of visual improvement. The cumulative probability of doubling of the visual angle was 52% over 6 years of follow-up, and this occurred at a higher rate in the presence of preoperative retinal or optic nerve lesions (HR (95% CI) 4.49 (1.41 to 14.29)). Within 3 months after operation, uveitis was more likely to develop in female patients (OR (95% CI) 6.21 (1.41 to 27.43)) and in the presence of significant intraoperative posterior synechiae (OR (95% CI) 8.43 (1.09 to 65.41)); macular oedema was more likely to develop in patients who developed postoperative uveitis (OR (95% CI) 7.45 (1.63 to 34.16)). Nd:YAG capsulotomy occurred at a higher rate in patients aged (55 years (HR (95% CI) 2.28 (1.06, 4.93)) and in those with hydrogel IOLs (HR (95% CI) 3.71 (1.04 to 13.20)), and occurred at a lower rate in patients who had prophylactic systemic corticosteroids (HR (95% CI) 0.25 (0.11 to 0.59)), with plate-haptic silicone IOLs (HR (95% CI) 0.23 (0.08 to 0.64)) and three-piece silicone IOLs (HR (95% CI) 0.19 (0.05 to 0.74)) in comparison to those with polymethylmethacrylate IOLs. Conclusion: Most patients with uveitis achieve improved visual acuity after phacoemulsification, but an increasing rate of visual loss is observed in those with pre-existent macular or optic nerve lesions. Identifying patients who are at risk of postoperative complications should help in patient counselling and to pre-empt these complications by using preoperative prophylactic corticosteroids, careful IOL selection and postoperative intensive corticosteroids.

Cataract Surgery Outcomes in Patients with Chronic or Recurrent Uveitis

“…3,5,17 Previous studies have re- ported short and long-term visual improvement of ≥ 2 lines in up to 93% of patients. [18][19][20][21] In our study, 72.4% of the eyes showed ≥ 2 Snellen lines of visual improvement at the final visit.…”

“…Despite similar studies in the literature, we believe our study will provide guid- ance as regards creating a national database, considering the etiological variety of the uveitis cases. 3,5,[17][18][19][20][21] We believe further studies comparing groups with various uveitis subtypes and evaluating postoperative inflammation preferably with a laser flare meter are necessary.…”

“…[1][2][3] Favorable visual outcomes with standard phacoemulsification and simultaneous intraocular lens implantation (IOL) have been reported in many studies, with the absence of perioperative inflammation. [4][5][6][7][8][9] The inflammation in uveitis patients can be effectively controlled with the common use of potent immunomodulatory agents and waiting for an attack-free period of at least 3 months before performing surgery.…”

Epilens membrane simulating cataract in children with uveitis: a report of three cases

“…Cataracts are difficult to manage, particularly in children; therefore, choice of surgery should be based on the assessment of quality of vision; preoperative control of inflammation; and intraoperative issues such as poor visibility due to band keratopathy, myosis, synechiae, pupillary membranes, and bleeding (1) . Postoperative follow-up may also be challenging, and the frequency of complications may be higher than usual (1)(2)(3)(4)(5)(6) . However, diagnostic techniques and medical and surgical treatments have greatly improved, increasing surgical indications.…”

“…However, diagnostic techniques and medical and surgical treatments have greatly improved, increasing surgical indications. Furthermore, cataracts in children may be amblyogenic, which does not facilitate diagnosis and treatment of posterior segment complications (1)(2)(3)(4)(5)(6) .…”