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D. Diaz-Valle, M. Arino, J. Benitez-del-Castillo, R. Cuina, P. Arriola-Villalobos, N. Alejandre-Alba, R. Mendez-Fernández, J. García-Sánchez; Periocular Steroid Prophylaxis in Severe Posterior Uveitis Undergoing Phacoemulsification. Invest. Ophthalmol. Vis. Sci. 2008;49(13):382.
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To analyze the visual outcome and the incidence of postoperative uveitis and cystoid macular edema (CME) after phacoemulsification and intraocular lens (IOL) implantation in patients with severe posterior uveitis who were treated with a peribulbar steroid injection one-week before surgery.
We retrospectively review the charts of 12 patients (16 eyes) with severe uveitis and posterior segment involvement who underwent uneventful phacoemulsification and posterior IOL implantation. The uveitis had to be quiescent for a minimum of 3 months before surgery. All patients continued with their immunosuppressive treatment and received a peribulbar injection of 1 ml (6 mg) of a mixture of betamethasone phospate and acetate one-week before surgery. On days 1, 7, 28, 90 and 120 visual acuity (VA), aqueous flare and cells were measured and on days 30, 90 and 120 optical coherence tomography (OCT) was performed to determine the incidence of CME. Patients with only anterior forms of uveitis and those with less than 6 months of follow-up were excluded.
Diagnoses of uveitis included Behçet disease (2 eyes), idiopathic panuveítis (6 eyes), multifocal choroiditis with panuveítis (2 eyes), ocular sarcoidosis (2 eyes), multiple sclerosis associated intermediate uveitis (3 eyes) and ocular tuberculosis (2 eyes). Best corrected visual acuity improved in all patients. Average improvement was 3,3 ± 2,5 Snellen acuity lines (range, 1 to 8 lines). Eight eyes (50%) attained final VA better than or equal to 20/40. Postoperative CME was detected in 2 eyes (12%) and recurrence of uveitis in 2 eyes (12%). There were no complications related to periocular steroid injections.
Preoperative peribulbar steroid prophylaxis and phacoemulsification with posterior IOL implantation was safe and effective in patients with severe uveitis. The incidences of recurrence of uveitis and postoperative CME in these severe forms of uveitis were lower or similar than those reported previously and this form of prophylaxis could be of special value in the prevention of CME development or worsening.
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