Small-incision cataract surgery in patients with Fuch’s heterochromic iridocyclitis

Abstract

Introduction: Fuch's heterochromic iridocyclitis (FHI) is often complicated by cataract formation. Objective: To assess the results of small-incision cataract surgery (SICS) in FHI and to study the effect of preoperative factors on postoperative vision. Materials and methods: Sixty-three eyes of 59 patients with Fuchs heterochromic iridocyclitis who had SICS with in-the-bag implantation of intraocular lens (IOL) were evaluated retrospectively; and the primary and secondary outcome measures evaluated were the postoperative vision and complication rate. Results: The mean age was 39.22 ± 4.95 years. The mean pre-operative vision was 0.75 ± 0.24 Log MAR units. The mean final vision was 0.27 ± 0.10 Log MAR units (P = < 0.001). At the final follow-up, 84.1 % of the patients had a final Snellen's vision of 6/12 or better. The mean follow-up period was 12.06 ± 2.06 months. The causes of corrected distance visual acuity (CDVA) worse than 6/60 were vitreous opacities, posterior keratic precipitates (KPs), glaucoma, persistent uveitis and cystoid macular edema (CME). Preoperative factors like iris atrophy (P = 0.973), heterochromia (P = 0.10) and vessels in angle (P = 0.074) did not have a significant effect on the final vision. On the contrary, vitreous opacities (P = 0.002) and posterior KPs (P = 0.009) had a significant effect on the final visual outcome. Conclusion: SICS with in-the-bag implantation of IOL in patients with Fuch's heterochromic iridocyclitis resulted in good visual outcomes. SICS in complicated cataracts can be performed in rural settings and eye camps with minimal instrumentation, obviating the need for referral to tertiary care centres. Pre-operative factors like vitreous opacities and posterior KPs have a significant effect on the final vision.

Phacoemulsification Versus Manual Small Incision Cataract Surgery in Patients With Fuchs Heterochromic Iridocyclitis

“…This may be of significance in manual SICS where manipulation of the nucleus is done in the AC close to the endothelium. 15 In the present study, although the mean endothelial cell loss 6 months postoperatively was significantly higher as compared with age-related cataract (20.5% in the phacoemulsification group and 19.2% in the SICS group), the difference between the 2 study groups at 6 months was not significant (P = 0.234).…”

Long-term outcomes of small-incision cataract surgery in patients with uveitis

“…Secondly, use of preoperative steroids ( P = 0.005) had significantly better visual outcome. In the study by Bhargava et al ,[ 7 ] however, visual outcome was not significantly influenced by the etiological type of uveitis (ANOVA, P = 0.062). This difference could be attributable to a longer follow-up duration (22 ± 11.5 months) in a relatively larger sample size ( n = 283 vs. 64) of patients in the present study.…”

“…Bhargava et al . [ 7 ] reported recurrence in four eyes (6.3%) when small-incision cataract surgery was performed in patients with FHC during 12 months of follow-up. Another study by Bhargava et al .…”

“…[ 10 ] In another study in patients with FHC, Bhargava et al . [ 7 ] found that 4.8% eyes with medically controlled glaucoma developed a sustained rise of the IOP despite a maximum-tolerated topical therapy. Out of these, one eye (1.6%) had an Ahmed glaucoma valve done.…”

“…However, these studies had limitations due to a small sample size and relatively smaller follow-up duration. [ 6 7 ]…”