Abstract
Purpose: :
To determine the incidence of and associated risk factors for chronic uveitis after cataract surgery.
Methods: :
This is a retrospective cohort study of patients undergoing elective cataract surgery. A total of 17,757 eyes were identified and the medical records of 42 eyes (of 35 patients) and 2320 eyes (of 1608 patients) that did and did not develop chronic uveitis respectively were reviewed. Patients were identified using procedure billing codes and cross-matched with international classification of diseases (ICD)-9 codes for uveitis. Chronic uveitis was defined as persistent intraocular inflammation and need for immunosuppressive therapy for ≥ 6 months after surgery. Patients were excluded if they had a prior diagnosis of uveitis, penetrating trauma, endophthalmitis, neovascular glaucoma, or previous intraocular surgery of any kind.
Results: :
Of 17,757 cataract surgeries performed, 42 eyes of 35 patients developed chronic uveitis (0.24%). Fifteen of these eyes (36%) experienced 1 or more of the following intraoperative complications: posterior capsular rupture, vitreous loss, anterior vitrectomy, and unplanned placement of an intraocular lens in the sulcus or anterior chamber. Final best corrected visual acuity was 1.16 ± 0.29 logMAR units (20/300 Snellen equivalent) in those eyes with chronic uveitis that experienced intraoperative complications and 0.47 ± 0.13 logMAR units (20/60 Snellen equivalent) in those eyes that underwent uncomplicated surgery (P < 0.05). Eleven of the 35 patients underwent consecutive cataract surgery (< 4 weeks apart) but developed unilateral chronic uveitis. Intraoperative complications occurred in 54.5% of those eyes with chronic uveitis compared to 0% in the fellow eyes (P < 0.05). Median duration of inflammation was 8 months and 11.5 months in eyes with and without vitrectomy (P < 0.05). In a subgroup analysis of 2329 eyes, intraocular complications occurred in 44% and 8.3% of eyes that did and did not develop chronic uveitis respectively (P = 0.01).
Conclusions: :
In this series, chronic uveitis developed after approximately 1 in 400 cataract surgeries and was associated with poorer visual outcomes. Uveitis occurred more frequently in eyes experiencing intraoperative complications and duration of inflammation was reduced by early vitrectomy.
Keywords: treatment outcomes of cataract surgery • uveitis-clinical/animal model