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Jean-Louis Bacquet, Audrey Fel, Nathalie Butel, Anne-Laure Remond, Phuc Lehoang, Bahram Bodaghi; Cataract surgery in adult patients with uveitis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):679.
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© ARVO (1962-2015); The Authors (2016-present)
To determine current challenges and visual results in patients with uveitis who underwent cataract surgery in 2013.
We retrospectively collected data from every consecutive uveitis patient who underwent cataract surgery in our tertiary eye care centre during the year 2013 and studied demographic data (age, gender) along with uveitis etiology and therapeutic management. Surgical details included the use of iris hooks, the rate of capsular rupture, the use of anterior capsule coloration. Pre and post operative anterior chamber flare was evaluated by laser flare photometry. Postoperative rate of macular edema (ME), ocular hypertension, epiretinal membrane (ERM) was also evaluated. Every patient was operated by the same surgeon (BB) and received a subconjunctival injection of dexamethasone at the end of the procedure. Use of perioperative oral prednisone was noted.
Twenty eight eyes of 24 patients were operated. The mean age was 57.6 [18 - 79, σ = 18.3], and 24 were female (85.6%). Uveitis origin was unknown for 6 patients (25%), due to Mycobacterium Tuberculosis hypersensivity in 4 patients (16.7%) and Vogt-Koyanagi-Harada disease in 2 patients (8.3%). Other patients had a different etiology for each case. Preoperative mean best corrected visual acuity (BCVA) was 0.90 logMar [0.1 - 2.3, σ = 0.68] . A week after surgery mean BCVA was improved to 0.26 logMar [0 - 1,3, σ = 0.37]. A month later, mean BVCA was 0.26 logMar [0- 1, σ = 0.34]. BCVA was 0.38 logMar (19 patients) at 6 months and 0.27 logMar (11 patients) at one year. The mean preoperative flare value was 26.4 ph/ms [7 - 198, σ = 39.9]. It increased to 42.8 ph/ms [7.3 - 178.2, σ = 47.7] at one day and 35.0 ph/ms [7 - 313.3, σ = 63.9] at one week. ME was noted postoperatively in 11 eyes (39%), of which 4 were preexistant. Four eyes (14.3%) had inflammatory glaucoma and ERM was noticed on OCT examination in 6 eyes (21.4%). There was no capsular rupture. Iris hooks were used in 7 procedures (25%). Oral prednisone was used prior to surgery in 6 patients (25%) and after surgery in 10 patients (41.6%).
Cataract surgery in adult patients with uveitis has a satisfactory outcome in most of the cases. It is important to achieve a strict preoperative control of ocular inflammation. The incidence of complications such as macular edema, epiretinal membrane or glaucoma has been dramatically reduced by an appropriate management of the disease.
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