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...