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K. Biggee, A. Palestine, T. Mor; The Epidemiology of Uveitis After Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5058.
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To determine whether there was a significant incidence of prolonged or recurrent uveitis after cataract extraction and whether differences among surgical techniques and/or patient characteristics predispose patients to this disease.
A retrospective case control study was conducted of 1422 eyes and 1140 patients who underwent cataract extraction performed by a resident physician from 2002-2007 at the Washington National Eye Center. Incident cases were defined as those patients who underwent cataract extraction and then developed a first time ICD9 coded diagnosis of uveitis occurring two months or more postoperatively. Control cases were then chosen randomly from the group of patients without uveitis. A chart review of patient characteristics and surgical techniques was conducted. The results were then analyzed using Student T-test for linear data and Chi square test for discrete data.
63 patients (67 eyes) out of 1140 patients (1422 eyes) had a first time diagnosis of uveitis after cataract extraction occurring two months or more postoperatively, giving an incidence proportion of 5.5% and 4.7% respectively. 66% of cases involved a chronic persistent anterior uveitis while 14% involved a recurrent type. Cases of persistent uveitis lasted a median of 5 months in those who underwent phacoemulsification compared to 4 months in those who underwent extracapsular cataract extraction (p = 0.0545). When compared to controls, the cases were more likely to be of African or African American descent (87.3% in cases vs 67.03% in controls, p = .007). 25.37% of cases reported the use of ICG or Tryphan Blue during surgery vs 7.78% of controls (p = .005). 32.26% of cases reported the use of a steroid in combination with a nonsteroidal anti-inflammatory (NSAID) eye drop post operatively compared to 14.44% of controls (p = .016). There were no statistically significant differences among patient age, sex, type of cataract extraction, eye axial length, type of intraocular lens implant, post operative visual acuity, or surgical complications including posterior capsule rupture.
This study found a significant incidence of prolonged or recurrent uveitis after cataract surgery that has not been previously reported. The results suggest that patients of African or African American descent may be at higher risk for this disease. The increased likelihood of uveitis in patients who had ICG or Tryphan blue used during surgery and in those who were taking a steroid plus a NSAID eye drop postoperatively are associations that warrant further study.
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