Cataract Surgery Outcomes in Patients with Non-ocular Autoimmune Disease

Abstract

Introduction While phacoemulsification cataract extraction is generally highly effective and safe, patients with a history of uveitis are at higher risk for postoperative complications and often require a modified perioperative medication regimen. No data exists on risks of postoperative complications and persistent anterior uveitis (PAU) in patients with non-ocular autoimmune disease. Methods Medical records were reviewed of patients who underwent phacoemulsification cataract surgery with intraocular lens implantation between January 1, 2014 and December 31, 2019 at the University of Colorado Hospital (UCH) as part of a retrospective cohort study. Exclusion criteria included patient history of ocular inflammation and cataract surgery combined with another intraocular surgery. Patients were only included as having autoimmune disease if the diagnosis was confirmed by a relevant specialist at UCH. Patients with autoimmune disease were then stratified into systemic versus organ-specific autoimmune disease, and patients with systemic autoimmune disease were further stratified into immunosuppressed and not immunosuppressed at the time of cataract surgery. Patients with PAU were identified according to the Standardization of Uveitis Nomenclature Working Group. Data including sex, race/ethnicity, intraoperative cumulative dissipated energy (CDE), and postoperative best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were obtained. Results A total of 422 eyes from 248 patients had confirmed autoimmune disease, compared to a control group of 10,201 eyes. The autoimmune and systemic autoimmune disease groups were not more likely to have postoperative complications or PAU compared to the control group. Immunosuppression status among the systemic autoimmune disease group was also not associated with postoperative complications or PAU. Conclusion Patients with non-ocular autoimmune disease do not appear to be at higher risk for postoperative complications, including worse BCVA or increased rates of IOP elevation and PAU, following phacoemulsification cataract surgery. These patients do not appear to require modification of the typical perioperative medication regimen.

Early and Late Complications after Cataract Surgery in Patients with Uveitis

“…However, at the three-month mark postoperation, the CMT was found to be significantly thicker compared with preoperative values (p = 0.010). These findings are consistent with the research conducted by Deng et al, who also investigated CMT 12 months after cataract surgery and similarly reported no significant change in macular thickness before and after surgery [30].…”

“…The mean intraocular pressure (IOP) before surgery in our study was 1.15, and at the end of the follow-up period, it decreased to 14.22. This observation aligns with the findings of Rachel et al and Deng et al, who reported a decrease in IOP from 14.9 to 13.5 and 14.32 to 13.54, respectively [29,30]. These consistent results suggest that IOP reduction can be achieved after cataract surgery in patients with uveitis.…”