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Sandra Hu-Torres, Reena Rasheed, C. Stephen Foster; Multifocal IOL implantation in Patients with Uveitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3006.
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To evaluate the results after cataract extraction with phacoemulsification and implantation of a multifocal intraocular lens (IOL) in patients with a history of uveitis.
A retrospective descriptive case series was performed for all patients with a history of uveitis and cataract who underwent phacoemulsification with posterior chamber multifocal IOL (Restore) or (Technis) implantation between October 2006 and October 2011 at Massachusetts Eye Research and Surgery Institution (MERSI).
32 eyes from 19 patients age 24 to 71 year old. (mean 47.2) with a history of different types of uveitis in remission underwent multifocal IOL implant between October 2006 and October 2011. Follow-up ranged from 7 to 72 months (mean 31.3 months). Remission prior to surgery varied from 1 to 40 months (mean 12.7 months). Overall 28.1% (n=9) had a prior history of CME while 71.8% (n=23) did not. At final postoperative follow-up 78.1% (n=25) of eyes achieved a distance acuity of 20/25 or better, 16 with 20/20 and 9 with 20/25. 15.6% of eyes (n= 5) did not achieve an improvement in vision, with 4 eyes at the same acuity postoperatively and one eye with worse acuity. 42.1% (n=8) of patients reported spectacle independence while 57.8% (n=11) still relied on reading glasses. On the satisfaction scale of 1 to 5, (1 = very dissatisfied and 5 = very satisfied) with multifocal lens, 47.3% (n=9) gave a satisfaction rating of 1-2, 5% (n=1) of 3, and 47.3% (n=9) of 4-5. Common reasons for dissatisfaction with the multifocal lens are: continued need for reading glasses (n=5), persistent halos (n=2) and decreased night vision (n=2). Of note, 83.3% (5/6) patients with a prior history of CME required reading glasses on follow-up compared to 46.1% (6/13) who did not have prior CME.
Patients with uveitis, when in remission or well controlled, are not contraindicated for multifocal lens implant. However, spectacle independence at near with multifocal implantation may be unpredictable in such patients. A history of CME may be associated with poor visual acuity at near postoperatively in these patients.
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