Risk factors for poor visual outcome following cataract surgery in Vogt-Koyanagi-Harada disease

Quek, Desmond Tung-Lien; Jap, Aliza; Chee, Soon Phaik

doi:10.1136/bjo.2010.184796

Cited by 21 publications

(23 citation statements)

References 22 publications

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“…[ 16 ] This is supported by studies that show the similar incidence of CMO in eyes with and without uveitis. [ 16 33 ] The incidence of PCO (58%–76%, of which 42%–45% require Nd:YAG capsulotomy)[ 16 47 ] is also comparable to that in age-matched nonuveitic eyes. [ 49 ]…”

Section: Visual Outcomes Of Cataract Surgery In Different Types Of Uvmentioning

confidence: 65%

“…CMO is uncommon in VKH syndrome[ 48 ] and is possibly a complication of cataract surgery rather than of VKH syndrome, especially if the disease was quiescent preoperatively. [ 16 ] This is supported by studies that show the similar incidence of CMO in eyes with and without uveitis. [ 16 33 ] The incidence of PCO (58%–76%, of which 42%–45% require Nd:YAG capsulotomy)[ 16 47 ] is also comparable to that in age-matched nonuveitic eyes.…”

Section: Visual Outcomes Of Cataract Surgery In Different Types Of Uvmentioning

confidence: 68%

“…In a series of 50 eyes by Quek et al ., 82% improved by 2 or more Snellen lines, with 68% achieving a BCVA of 6/12. [ 16 ] Ganesh et al . [ 47 ] similarly reported that the visual acuity 80% of eyes with VKH syndrome improved by 1 or more Snellen lines.…”

Section: Visual Outcomes Of Cataract Surgery In Different Types Of Uvmentioning

confidence: 99%

“…Eyes with anterior uveitis have the best outcome, with 91.1% to 94.5% achieving BCVA of 20/40 or better. [ 11 15 ] Eyes with posterior or panuveitis (57.4%),[ 11 ] Vogt–Koyanagi–Harada (VKH) disease (67.1%–68%),[ 11 16 ] Behcet's disease (12.2%–16.7%),[ 11 17 ] and sympathetic ophthalmia have substantially worse visual outcomes,[ 18 ] likely due to concomitant chorioretinal injury.…”

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confidence: 99%

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Decision-making and management of uveitic cataract

Chan

Chee

2017

Indian J Ophthalmol

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The visual outcome of uveitic cataract surgery depends on the underlying uveitic diagnosis, the presence of vision-limiting pathology and perioperative optimization of disease control. A comprehensive preoperative ophthalmic assessment for the presence of concomitant ocular pathology, with particular emphasis on macula and optic nerve involvement, is essential to determine which patients will benefit from improved vision after cataract surgery. Meticulous examination in conjunction with adjunct investigations can help in preoperative surgical planning and in determining the need for combined or staged procedures. The eye should be quiescent for a minimum of 3 months before cataract surgery. Perioperative corticosteroid prophylaxis is important to reduce the risk of cystoid macular edema and recurrence of the uveitis. Antimicrobial prophylaxis may also reduce the risk of reactivation in eyes with infectious uveitis. Uveitic cataracts may be surgically demanding due to the presence of synechiae, membranes, and pupil abnormalities that limit access to the cataract. This can be overcome by manual stretching, multiple sphincterotomies or mechanical dilation with pupil dilation devices. In patients <2 years of age and in eyes where the inflammation is poorly controlled, intraocular lens implantation should be deferred. Intensive local and/or oral steroid prophylaxis should be given postoperatively if indicated. Patients must be monitored closely for disease recurrence, excessive inflammation, raised intraocular pressure, hypotony, and other complications. Complications must be treated aggressively to improve visual rehabilitation. With proper patient selection, improved surgical techniques and optimization of peri- and post-operative care, patients with uveitic cataracts can achieve good visual outcomes.

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Section: Visual Outcomes Of Cataract Surgery In Different Types Of Uvmentioning

confidence: 65%

Section: Visual Outcomes Of Cataract Surgery In Different Types Of Uvmentioning

confidence: 68%

Section: Visual Outcomes Of Cataract Surgery In Different Types Of Uvmentioning

confidence: 99%

mentioning

confidence: 99%

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Decision-making and management of uveitic cataract

Chan

Chee

2017

Indian J Ophthalmol

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“…Prolonged steroid treatment and recurrent ocular inflammation are the main risk factors for its development 1,30. Cataract surgery is usually recommended only when the inflammation is quiescent for at least 3 months and should be performed with preoperative steroid cover for up to 2 weeks 162,163. Other less common complications that might be responsible for visual loss in patients with VKHD include peripapillary and macular CNVs,164 which develop in up to 14.7%,165 and subretinal fibrosis 2,30,34.…”

Section: Complications Associated With Vkhdmentioning

confidence: 99%

Vogt–Koyanagi–Harada syndrome – current perspectives

Baltmr¹,

Lightman²,

Tomkins-Netzer³

2016

OPTH

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Vogt–Koyanagi–Harada syndrome is a cause of noninfectious panuveitis, leading to significant vision loss in many patients. It is an autoimmune disease occurring in genetically susceptible individuals and clinically presents as bilateral panuveitis with serous retinal detachments and hyperemic, swollen optic discs, which are associated with neurological and auditory manifestations. Early diagnosis and prompt and adequate treatment with immunosuppressive agents (corticosteroids and other immunosuppressive drugs) may halt disease progression and prevent recurrences and vision loss. This review summarizes the current knowledge on the variable clinical aspects of this disease, highlighting diagnostic and treatment strategies.

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