New surgical approach in cases of cataract with ocular Stevens-Johnson syndrome

Sharma, Namrata; Aron, Neelima; Venugopal, Renu; Sangwan, Sushil; Titiyal, Jeewan S; Agarwal, Tushar

doi:10.1016/j.jcrs.2016.09.012

Cited by 12 publications

(24 citation statements)

References 5 publications

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“…Surface stabilization procedures should be performed before undertaking cataract surgery. Three studies from India have described the outcomes of cataract surgery in patients with SJS/TEN (34)(35)(36). Phacoemulsification was the most common surgical procedure performed.…”

Section: Cataract Surgery In Sjs/tenmentioning

confidence: 99%

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India

et al. 2021

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Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of rare, severe immunological blistering skin reactions which are triggered by medication intake or infections. The acute phase is characterized by necrolysis of the skin and desquamation of mucosa, primarily oral and ocular, with significant mortality rates. The chronic phase is characterized by multi-organ sequelae with increased rates of morbidity and reduced quality of life for patients who have survived the acute phase. Since the primary goal in the acute phase is saving the life of the patient, ocular involvement is often missed and a significant proportion of patients present to an ophthalmologist with the chronic ocular sequelae. In India, chronic ocular sequelae and low vision are observed in two-thirds of patients who present in the chronic phase of SJS/TEN. In the chronic phase of ocular involvement, there are definite windows of opportunity which if targeted with specific interventions such as scleral lenses and mucous membrane grafts can help reduce the incidence of corneal blindness and improve the quality of life for patients with SJS/TEN. Over the last decade, several studies from India have advanced the understanding of the natural course of ocular involvement in SJS/TEN and the outcomes of timely interventions in the chronic phase of the disease. We present an overview of the epidemiology of ocular complications of SJS/TEN in India, the specific challenges faced in the management of ocular complications in the acute stage and recent advances in management of the chronic ocular complications of the disease.

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Section: Cataract Surgery In Sjs/tenmentioning

confidence: 99%

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India

et al. 2021

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“…Early surgical intervention after stabilizing the ocular surface is preferred especially in patients with SJS and OCP; as both the density of cataract and keratopathy progress with time making surgical intervention more onerous (11,23). Phacoemulsification was the most common type of surgery performed in all the three categories of DED and is a feasible option when planned before media clarity gets significantly compromised (10,23,24). While phacoemulsification can still be performed in eyes with significant keratopathy with the assistance of an endoilluminator (10,25), ECCE needs to be performed in the presence of severe keratopathy (23).…”

Section: Discussionmentioning

confidence: 99%

“…Phacoemulsification was the most common type of surgery performed in all the three categories of DED and is a feasible option when planned before media clarity gets significantly compromised (10,23,24). While phacoemulsification can still be performed in eyes with significant keratopathy with the assistance of an endoilluminator (10,25), ECCE needs to be performed in the presence of severe keratopathy (23). Two thirds of the eyes which needed ECCE in our cohort had dry eye associated with CC, which implies a higher level of surgical complexity.…”

Section: Discussionmentioning

confidence: 99%

“…In order to achieve successful results, the need to understand the various factors governing the outcomes of cataract surgery in eyes with pre-existing DED cannot be overemphasized. Most studies in the existing literature have looked at outcomes of cataract surgery in specific disorders causing severe DED in smaller cohorts (10)(11)(12). Thus, in the current study, the authors have attempted to study the etiologybased visual outcomes and complications of cataract surgery in a larger cohort of patients with DED.…”

Section: Introductionmentioning

confidence: 99%

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Cataract Surgery in Dry Eye Disease: Visual Outcomes and Complications

et al. 2020

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Purpose: To describe the visual outcomes and complications following cataract surgery in dry eye disease (DED). Methods: This retrospective study included 668 eyes of 399 patients with DED, who underwent cataract surgery between 2011 and 2019 at our multi-tier ophthalmology hospital network. Based on etiology, they were divided into three groups: cicatrizing conjunctivitis (CC), meibomian gland dysfunction (MGD), and Sjogren's syndrome (SS). The data on demographics, visual impairment, surgical technique, visual outcomes, and complications were collected using an electronic medical record system. Median LogMAR best corrected visual acuity (BCVA) with interquartile range (IQR) was compared using Wilcoxon's rank sum test. Results: The median age at which cataract surgery was performed was 58 (IQR: 47-65) years. Etiology of DED was CC in 279, MGD in 255, and SS in 134 eyes. Most (471) eyes underwent phacoemulsification, under peribulbar anesthesia (548) through a temporal clear corneal incision (209) with foldable intraocular lens implantation (417). The overall median LogMAR BCVA improved from 1.1 (IQR: 0.6-2.1) at baseline to 0.3 (IQR: 0.1-0.7) and 0.1 (IQR: 0-0.65) at 1 and 6 weeks (p < 0.0001) post-operatively. The median 6 weeks post-operative BCVA was 0.3, 0.1, and 0.1 in CC, MGD, and SS, respectively, and significantly better than at baseline (p < 0.0001). The leading cause of sub-optimal vision was corneal scarring (44; 9%), and the most common complication was posterior capsular rupture with vitreous loss (23; 3%). Conclusion: Cataract surgery has good visual outcomes in patients with DED, without any disconcerting rate of complications. Pre-existing keratopathy is the main determinant of the extent of post-operative visual recovery.

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“…In extreme cases wherein the scar is dense, preoperative counseling should include the possible need for a keratoplasty, if eligible, based on postoperative visual outcome. [ 5 11 26 ]…”

Section: Choosing An Iol In Osdmentioning

confidence: 99%

Perioperative nuances of cataract surgery in ocular surface disorders

Agarwal

Srinivasan

Harwani

et al. 2022

Indian Journal of Ophthalmology

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Ocular surface disorders (OSDs) constitute a varied spectrum of conditions that could be associated with dryness, compromised limbal status, varying grades of forniceal obliteration, corneal scars, and a possible underlying immune etiology. These associations adversely impact surgical outcomes in the eye. One of the treatable causes of decreased vision in these eyes is cataracts which could be secondary to the disease, its treatment, or age-related. The compromised ocular surface status can interfere with decision-making regarding the technique of cataract surgery, preoperative biometry for intraocular lens (IOL) power calculation, and intraoperative visibility, increasing the possibility of complications and compromising the final visual outcome. The postoperative course can be affected by complications, including melt and infection. Stabilization of the ocular surface by medical or surgical means, and appropriate management of underlying immune etiology, if any, helps improve and maintain a healthy ocular surface, optimizing cataract outcomes. With the help of pre, intra, and postoperative tools and means, such as punctal occlusion, ocular surface reconstruction, systemic immunosuppression, illuminators, capsule staining dyes, optical iridectomy, prosthetic replacement of the ocular surface ecosystem (PROSE) lenses, and others, the visual outcome post-cataract surgery in these eyes can be maximized. This article highlights the nuances of performing cataract surgery in various OSDs and the need to have a comprehensive stepwise approach is emphasized.

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New surgical approach in cases of cataract with ocular Stevens-Johnson syndrome

Abstract: None of the authors has a financial or proprietary interest in any material or method mentioned.

Cited by 12 publications

References 5 publications

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India

Cataract Surgery in Dry Eye Disease: Visual Outcomes and Complications

Perioperative nuances of cataract surgery in ocular surface disorders

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