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O. Abbasi, Z. Ahmad, B. A. Hughes, T. H. Mahmoud; Combined Cataract Extraction, PCIOL, Pars Plana Vitrectomy, Retisert Implant, and Pars Plana Tube (CPR-PT) in Chronic, Advanced, Non-Infectious Uveitis With Cataract and Glaucoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5869.
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To assess the safety and efficacy of combined cataract extraction (CE) with posterior chamber intraocular lens (PCIOL), pars plana vitrectomy (PPV), Fluocinolone Acetonide intravitreal implant (Retisert), and Ahmed valve with pars plana tube (PPT) in eyes with chronic, advanced, non-infectious uveitis with cataract and glaucoma.
A retrospective chart review was performed for all patients who had Retisert implantation for posterior non-infectious uveitis combined with CE/PCIOL, PPV, and PPT. Outcome measures included visual acuity (Va), control of intraocular pressure (IOP), inflammation, and complications. The Wilcoxon signed rank test was used for statistical analysis.
Eight eyes of 5 pts, ages 39 to 60, were included, with a mean follow up of 11 months. All eyes had a single procedure consisting of synechiolysis, CE/PCIOL, Retisert implant, PPV, and PPT. Two eyes had pre-existing anterior chamber tubes which were diverted to the PP secondary to corneal erosion. Mean Va improved significantly from pre-op Logmar 1.62 (SD 0.64, Snellen ~20/800) to post-op LogMar 0.22 (SD 0.19, Snellen ~20/30) (p=0.001). Mean post-op IOP (14 mmHg, SD 2.51) was significantly lower than mean pre-op IOP (20.1 mmHg, SD 6.8) (p=0.04). All patients were on fewer glaucoma drops post-op (0.5, SD 0.93) than pre-op (2.125, SD 1.13) (p=0.02). No patients were on systemic prednisone compared to a mean pre-op dose of 48.8 mg (SD 33.1) (p=0.004). Three pts were on systemic immunosuppressives pre-op which were discontinued. Inflammation was well controlled in all eyes at final follow up. Two eyes developed iris bombe, which was relieved with peripheral laser iridotomy.
Combining Retisert implant with CE/PCIOL, PPV, and PP tube appears to be a reasonable option for patients with chronic, advanced, non-infectious uveitis, cataract and glaucoma. The combined CPR-PT procedure allows rapid visual rehabilitation with good control of intraocular inflammation and IOP with less dependency on topical anti-glaucoma medication, systemic steroids, and immunosuppressive therapy, and without major short term complications.
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