Perioperative Use of Triamcinolone in Uveitic Eyes Undergoing Cataract Extraction

Abstract

Abstract: : Purpose: To report the outcome of uveitic patients undergoing cataract extraction treated with concurrent intravitreal triamcinolone (TA). Methods: 10 eyes of 10 patients were enrolled prospectively. All had posterior uveitis diagnoses and would have required pre–operative oral steroid prophylaxis prior to cataract surgery. All eyes were quiet for at least 3 months pre– operatively and all but one had had documented macular oedema at some time pre–operatively. All but one underwent uncomplicated cataract surgery. One case was complicated by a capsule tear with no vitreous loss. Post–op topical antibiotics & steroids were given in all cases. Follow up was at day 1, week 1, one and three months but also as dictated by clinical need. Best corrected visual acuity, grading of inflammation, intraocular pressure (IOP), complications and the reasons for any reduced acuity were documented at each visit. Results: All patients experienced an improvement in vision. Eight of the ten eyes improved to 6/12 or better. Both of the eyes which did not improve to ≥6/12 had pre–existing vision–limiting posterior segment disease. The mean improvement of vision from pre–operatively to day 1, day 7, day 30 and day 90 was found to be 1.6, 2.5, 3.2, 3.13 lines of Snellen acuity, respectively. The only complications witnessed were raised IOP in 2 eyes (1 at day 1 with retained viscoelastic and one at day 7) and one eye which developed 4+ cells in the anterior chamber on day 1 post–op. This eye settled on hourly topical steroid drops and was 6/9 one week later. The 2 eyes which developed high IOP settled with short term use of topical hypotensive agents. No eye developed macular oedema in the 3 months follow up (the incidence of which has been reported as 26% at this institution following an identical protocol but without intravitreal TA). Conclusions: It is standard practice to give systemic steroids to uveitic patients with posterior segment disease undergoing cataract surgery, to limit the inflammatory response which can be severe. This study indicates that cataract extraction by phacoemulsification with concurrent intravitreal TA is an excellent treatment choice. Intravitreal TA did not change the profile of surgical complications and there were no significant side effects from the treatment. All of this was achieved without the risks, complications and side effects inherent with systemic steroids.

Keywords: autoimmune disease • corticosteroids • cataract