Cataract Surgery in Uveitis

Abstract

<jats:p>Cataract surgery in uveitic eyes is often challenging and can result in intraoperative and postoperative complications. Most uveitic patients enjoy good vision despite potentially sight-threatening complications, including cataract development. In those patients who develop cataracts, successful surgery stems from educated patient selection, careful surgical technique, and aggressive preoperative and postoperative control of inflammation. With improved understanding of the disease processes, pre- and perioperative control of inflammation, modern surgical techniques, availability of biocompatible intraocular lens material and design, surgical experience in performing complicated cataract surgeries, and efficient management of postoperative complications have led to much better outcome. Preoperative factors include proper patient selection and counseling and preoperative control of inflammation. Meticulous and careful cataract surgery in uveitic cataract is essential in optimizing the postoperative outcome. Management of postoperative complications, especially inflammation and glaucoma, earlier rather than later, has also contributed to improved outcomes. This manuscript is review of the existing literature and highlights the management pearls in tackling complicated cataract based on medline search of literature and experience of the authors.</jats:p>

Cataract Surgery with Primary Lens Implantation in Children with Chronic Uveitis

“…[4][5][6] In children with uveitis, inflammation after cataract surgery is often intense 7 and aggressive perioperative control of intraocular inflammation is essential. 1,5,[8][9][10] Uncontrolled, perioperative inflammation can lead to major complications, such as posterior synechiae, 11 posterior capsule opacification, 1,9,[11][12][13][14][15][16][17][18] cell proliferation on the intraocular lens (IOL), 9,11 Elschnig pearls, 9,15,16 secondary glaucoma, 1,9,11,[13][14][15]17,18 macular edema, 1,9,11,[13][14][15] and retinal detachment. 14 Various strategies have been tested and are still controversial, including eye left aphakic, 16 pars plana approach, 16 primary PMMA IOL implantation with or without heparin coating, 9 and use of foldable acrylic IOL.…”

Use of Intravitreal Dexamethasone Implant (Ozurdex) Prior to Cataract Surgery in Uveitic Patients

“…It is caused either by the inflammation itself, by the use of corticosteroid medications or by the combination of both [1,2].…”

Epilens membrane simulating cataract in children with uveitis: a report of three cases

“…Cataracts are difficult to manage, particularly in children; therefore, choice of surgery should be based on the assessment of quality of vision; preoperative control of inflammation; and intraoperative issues such as poor visibility due to band keratopathy, myosis, synechiae, pupillary membranes, and bleeding (1) . Postoperative follow-up may also be challenging, and the frequency of complications may be higher than usual (1)(2)(3)(4)(5)(6) . However, diagnostic techniques and medical and surgical treatments have greatly improved, increasing surgical indications.…”

“…However, diagnostic techniques and medical and surgical treatments have greatly improved, increasing surgical indications. Furthermore, cataracts in children may be amblyogenic, which does not facilitate diagnosis and treatment of posterior segment complications (1)(2)(3)(4)(5)(6) .…”