Decision-making and management of uveitic cataract

Abstract

The visual outcome of uveitic cataract surgery depends on the underlying uveitic diagnosis, the presence of vision-limiting pathology and perioperative optimization of disease control. A comprehensive preoperative ophthalmic assessment for the presence of concomitant ocular pathology, with particular emphasis on macula and optic nerve involvement, is essential to determine which patients will benefit from improved vision after cataract surgery. Meticulous examination in conjunction with adjunct investigations can help in preoperative surgical planning and in determining the need for combined or staged procedures. The eye should be quiescent for a minimum of 3 months before cataract surgery. Perioperative corticosteroid prophylaxis is important to reduce the risk of cystoid macular edema and recurrence of the uveitis. Antimicrobial prophylaxis may also reduce the risk of reactivation in eyes with infectious uveitis. Uveitic cataracts may be surgically demanding due to the presence of synechiae, membranes, and pupil abnormalities that limit access to the cataract. This can be overcome by manual stretching, multiple sphincterotomies or mechanical dilation with pupil dilation devices. In patients <2 years of age and in eyes where the inflammation is poorly controlled, intraocular lens implantation should be deferred. Intensive local and/or oral steroid prophylaxis should be given postoperatively if indicated. Patients must be monitored closely for disease recurrence, excessive inflammation, raised intraocular pressure, hypotony, and other complications. Complications must be treated aggressively to improve visual rehabilitation. With proper patient selection, improved surgical techniques and optimization of peri- and post-operative care, patients with uveitic cataracts can achieve good visual outcomes.

Combination of cataract surgery with intravitreal injection of dexamethasone intravitreal implant (Ozurdex) for uveitis-induced cataract

“…According to the Uveitis Guidelines of the Uveitis Society, experts generally believe that except for phacolysis-induced acute uveitis that requires a surgery as soon as possible, other uveitis-induced cataract should receive active anti-inflammatory treatment and suppress intraocular inflammation for one to three months before surgery. Some experts suggested that surgeries should be performed after at least three months of intraocular inflammation suppression [4][5] . Complete obliteration of anterior suspensions or mild aqueous flare are indications for intraocular inflammation suppression.…”

The elevated risk of sight-threatening cataract in diabetes with retinopathy: a retrospective population-based cohort study

“…Regarding the risk factors for developing sight-threatening cataracts other than DR, all the ophthalmic diseases enrolled in the multivariate analysis were correlated with the occurrence of sight-threatening cataracts. Glaucoma, uveitis and TPPV are known risk factors for cataract formation [ 4 , 5 , 9 ], and advanced age and inflammatory reactions in both DED and AMD may result in increased cataract development [ 38 , 39 ]. Cardiovascular diseases and inflammatory diseases are the two groups of systemic diseases associated with a higher cataract occurrence, but the exact pathophysiology needs further investigation.…”

“…In a recent study conducted in Asia and Oceania, the prevalence of cataract-induced blindness and moderate-to-severe visual impairment in the general population was more than 35% [ 3 ]. The associated ocular morbidities of cataracts include glaucoma and uveitis, and they can both lead to impaired vision [ 4 , 5 ]. Surgical management is always indicated for sight-threatening cataracts, although some complications may occur after surgery, such as postoperative endophthalmitis and cystoid macular oedema [ 6 , 7 ].…”

Surgical handling of uveitic membranes in pediatric phakic eyes

“…Apart from Varner,[ 3 ] Chan et al . [ 4 ] and Rosenberg et al . [ 5 ] literature describing the occurrence of pupillary inflammatory membrane as a separate entity, mimicking cataract and surgical handling of such a non-resolving thick fibrotic uveitic membrane and technique of its removal with an underlying clear lens in pediatric uveitis was found lacking.…”