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L. Reggiani, J.G. Orsoni, L. Zavota; Immunosuppressive Combination Therapy Protocol for Cataract Surgery in Autoimmune Uveitis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):204.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To report the outcomes of cataract surgery with intraocular lens implantation in patients with autoimmune uveitis , treated with an immunosuppressive combination therapy (ICT) protocol before, during and after surgery . Methods: A series of eyes with cataract caused by autoimmune uveitis which underwent phacoemulsification with in the bag intraocular lens implantation were retrospectively analyzed. Patients were operated in the Institute of Ophthalmology of the University of Parma between February 1996 and March 2001. A perioperative , ranging from 1 day before to 60 days after surgery , standardized ICT protocol, was used in all patients in order to minimise, when possible eliminate, the risk of uveitis exacerbation and recurrences induced by the surgical act. This protocol involved endovenous short-acting steroids, broad spectrum antibiotics and immunosuppressive agents (as Cyclophosphamide). Operative and postoperative complications, degree of early postoperative inflammation, best-corrected ( BCVA ) visual acuity at the end of follow-up were the main outcome measures. The rationale of the ICT protocol is discussed. Results: 22 eyes of 14 patients underwent surgery. Mean postoperative follow-up was 23 months (range 5-72). 19 eyes (86.3%) had an improvement of at least 2 lines ETDRS chart , with an average improvement of 7 lines. 19 eyes ( 86.3% ) attained final visual acuity > 20/40 4 eyes ( 18.1 % ) developed a clinically significant inflammation (Anterior Chamber cells> + ) in the immediate postoperative period ( 4- 7 day ), 2 of which( 9 % ) severe ( AC cells > = +++ or more, and/or fibrin ). Recurrence of uveitis occurred in 4 eyes (18.1 %) in the follow-up period, none in the first 2 months after surgery. Clinically observed cystoid macular edema was noted in 17 eyes preoperatively; only one eye experienced a worsening in the postoperative period. Posterior capsule opacification was present in 6 eyes ( 27.2 % ) which underwent Nd-YAG capsulotomy . No epiretinal membranes , hyperthony/ hypotony or posterior sinechiae were observed. Conclusions: The degree of early postoperative inflammation and the incidence of other common postoperative complications were lower than those previously reported in the literature. The perioperative ICT protocol used at the Institute of Ophthalmology Department of the University of Parma represents a safe and effective treatment for cataract surgery in patients with autoimmune uveitis .
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