Perioperative prophylaxis to prevent recurrence following cataract surgery in uveitic patients: a two‐centre, prospective, randomized trial

Mora, Paolo; Gonzales, Stefania; Ghirardini, Stella; Rubino, Pierangela; Orsoni, Jelka G.; Gandolfi, Stefano; Majo, F.; Guex-Crosier, Yan

doi:10.1111/aos.12955

Cited by 20 publications

(13 citation statements)

References 22 publications

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“…A single-surgeon retrospective study in 171 uveitic eyes reported that at 6 months, a VA of 20/40 or better was achieved in 71% of eyes 6. A small non-masked randomised controlled trial investigating the effect of perioperative oral corticosteroid in 52 uveitic eyes undergoing phacoemulsification reported a VA improvement from 0.68 to 0.31 logMAR in the standard therapy group (intensive topical corticosteroid) and from 0.75 to 0.20 in the intervention group (intensive topical plus oral corticosteroid) 13. During the 2-year follow-up of the Multicenter Uveitis Steroid Treatment Trial, 117 eyes underwent cataract surgery, where 62% of eyes achieved a VA of 6/12 or better at the 3-month postoperative visit, from a median of 56 letters at baseline to 79 letters at 3 months 14.…”

Section: Discussionmentioning

confidence: 99%

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Cataract surgery in uveitis: a multicentre database study

Chu

Dick

Johnston³

et al. 2017

Br J Ophthalmol

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SUBTITLE (35 words):Demographics, surgical factors and outcomes from 1173 eyes with uveitis undergoing cataract surgery were compared to control eyes using electronic medical records, which highlighted the increased complexity and management requirements of this patient group. AUTHORS: CORRESPONDING AUTHOR:Alastair K Denniston (Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. a.denniston@bham.ac.uk) KEYWORDS:Uveitis, cataract, phacoemulsification, real-world, database. WORD COUNT: (2866 post-revision) in main text STRUCTURED ABSTRACT (250 words): "Background/aims"Cataract is an important source of visual loss in patients with uveitis. Whether or not outcomes of cataract surgery in eyes with uveitis are worse compared to non-uveitic eyes have to date been compromised by lack of reliable estimates of benefit and harm, which require data from large cohorts. "Methods"Electronic medical record data were extracted from eight independent UK clinical sites for eyes undergoing cataract extraction between January 2010 and December 2014. 1173 eyes with a recorded diagnosis of uveitis were compared to a reference group of 95573 eyes from the same dataset. "Results"Uveitic eyes represented 1.2% of all eyes undergoing cataract surgery. Eyes in the uveitic group had worse pre-operative visual acuity (0.87 vs 0.65 logMAR units), were from younger patients and had shorter axial lengths and a higher incidence of ocular co-pathology including glaucoma. A greater number had documented small pupils, required additional surgical procedures, developed more intraoperative complications and had poorer post-operative visual acuity at all timepoints measured up to 6 months (0.41 vs 0.27 logMAR units at 12-24 weeks). "Conclusion"This large study cohort of eyes with a diagnosis of uveitis undergoing cataract surgery highlights more precisely the complex surgical demands, co-pathology and worse visual outcomes in this group. This data will allow more accurate pre-operative counselling and planning. Although improvement in visual acuity is achieved in most cases, prognosis should be guarded so patient expectations are met. Compared to the non-uveitic population, the mean post-operative visual acuity is between one to two lines worse at all time-points. INTRODUCTION:Cataract is a major cause of visual loss in patients with uveitis; up to 40% of the visual loss is either solely or largely due to cataract [1]. Surgical treatment may be effective but is associated with higher complication rates than in eyes without previous uveitis. Quantifying this risk is important in order to inform patients and surgeons as to the likely short-and long-term benefit or harm of undertaking cataract surgery, and may affect the timing of such surgery.Currently most data on cataract surgery in patients with uveitis comes from small case series or cohort studies, with data gathered over long time periods to attain sufficient numbers. As this may be so long that practice changes, the studies may not reflect current prac...

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Section: Discussionmentioning

confidence: 99%

“…However, where evidence is available, studies report a high rate of additional procedures, notably intraoperative iris hook use between 19% and 67%, but a low risk of intraoperative complications 6 13 15. The largest of these studies reported no posterior capsular ruptures in any of 171 uveitic eyes undergoing surgery 6…”

Section: Discussionmentioning

confidence: 99%

Cataract surgery in uveitis: a multicentre database study

Chu

Dick

Johnston³

et al. 2017

Br J Ophthalmol

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“…Intermediate uveitis, posterior uveitis and panuveitis account for around 10% of uveitis cases in the UK 10 but are more severe and more likely to cause vision loss. …”

Section: Description Of the Health Problemmentioning

confidence: 99%

“…Treatment failure: HURON trial Treatment failure in the HURON trial 48 was defined as a VH grade increase of ≥ 1 unit at weeks 3-8 or a VH of ≥ +1.5 at weeks [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. No data were reported in the journal article, 48 company submission 43 or clinical study report, 71 but a statistically significant difference between the DEX 700 arm and the sham arm (p < 0.001) was noted.…”

Section: Treatment Failurementioning

confidence: 99%

A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults

Squires

Poku

Bermejo

et al. 2017

Health Technol Assess

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Declared competing interests of authors: Fahd Quhill has received personal fees from Allergan for participation in medical education and training, and has participated in advisory boards given his clinical expertise in the role of steroids in diabetic macular oedema. He has also received support from Allergan to attend international conferences.Published November 2017 DOI: 10.3310/hta21680 This report should be referenced as follows: This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was commissioned and funded by the HTA programme on behalf of NICE as project number 15/64/07. The protocol was agreed in June 2016. The assessment report began editorial review in December 2016 and was accepted for publication in May 2017. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expre...

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“…In cases with long duration of absolute control of inflammation preoperatively, only intensive topical corticosteroids post operatively may be sufficient for favorable outcomes. Additional systemic corticosteroids may have no additional benefit in these patients [24].…”

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confidence: 98%

Recent Principles and Trends of Management of Uveitic Cataract

Ram¹

2017

AOVS

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Perioperative prophylaxis to prevent recurrence following cataract surgery in uveitic patients: a two‐centre, prospective, randomized trial

Cited by 20 publications

References 22 publications

Cataract surgery in uveitis: a multicentre database study

Cataract surgery in uveitis: a multicentre database study

A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults

Recent Principles and Trends of Management of Uveitic Cataract

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