Therapeutic potential of pupil coroplasty combined with phacomulsification and intraocular lens implantation against uveitis-induced cataract

Abstract

Background: Uveitis is a severe intraocular inflammation with high recurrence rate, which can induce cataract. This study aimed to evaluate the therapeutic effect of pupil coroplasty combined with phacomulsification and intraocular lens implantation (PPI) in uveitis-induced cataract.Methods: Total 28 patients with uveitis-induced cataract were enrolled. Within 3 months before the PPI, 7 cases accompanied with glaucoma maintained carteolol hydrochloride for lowering intraocular pressure, and 1 case maintained glucocorticoid for anti-inflammation. The baseline characteristics, treatment processes, and outcomes of enrolled cases were retrospectively analyzed. Hematoxylin and Eosin (HE) staining was performed to reveal the histopathological changes of iris tissues.Results: Iris hemorrhage was the only intraoperative complication observed in 2 cases. After the surgery, normal intraocular pressure, right position of intraocular lens, and improved visual gain (BCVA > 0.5) were achieved. Postoperative keratic precipitates was observed in 2 cases, which was recovered within 1 week. During the follow-up of 5-10 years, no recurrence of uveitis was found in 27 cases (96.43%). Uveitis only recurred in one case with the onset of ankylosing spondylitis. HE staining showed iris stroma (all samples), pigment cell hyperplasia in pigment epithelium (n = 9) and stroma (n = 19), inflammatory cell infiltration in iris (n = 7), and neovascularization in iris surface (n = 2).Conclusion: PPI improved the visual gain and prevented the long-term recurrence of uveitis in patients with uveitis-induced cataract, including those with preoperative intraocular pressure abnormality (glaucoma) and inflammation (active uveitis). Uveitis presented stroma atrophy, pigment cell hyperplasia, and inflammatory cell infiltration, even in a quiet state.