Types of intraocular lenses for cataract surgery in eyes with uveitis

Abstract

Background Cataract formation often occurs in people with uveitis. It is unclear which intraocular lens (IOL) type is optimal for use in cataract surgery for eyes with uveitis. Objectives To summarize the effects of different IOLs on visual acuity, other visual outcomes, and quality of life in people with uveitis. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2013), EMBASE (January 1980 to August 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to August 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 14 August 2013. We also performed forward and backward searching using the Science Citation Index and the reference lists of the included studies, respectively, in August 2013. Selection criteria We included randomized controlled trials (RCTs) comparing hydrophobic or hydrophilic acrylic, silicone, or poly(methyl methacrylate) (PMMA) IOLs with or without heparin-surface modification (HSM), with each other, or with no treatment in adults with uveitis, for any indication, undergoing cataract surgery. Data collection and analysis We used standard methodological procedures expected by The Cochrane Collaboration. Two review authors screened the search results and for included studies, assessed the risk of bias and extracted data independently. We contacted study investigators for additional information. We did not perform a meta-analysis due to variability in reporting and follow-up intervals for the primary and secondary outcomes of interest. Main results We included four RCTs involving 216 participants (range of 2 to 140 participants with uveitic cataract per trial) and comparing up to four types of IOLs. The largest study was an international study with centers in Brazil, Egypt, Finland, France, Japan, the Netherlands, Slovak Republic, Spain, and the USA; two studies were conducted in Germany and one in Saudi Arabia. There was substantial heterogeneity with respect to the ages of participants and etiologies of uveitis within and across studies. The length of follow-up among the studies ranged from 1 to 24 months after cataract surgery. The studies were at low risk of selection bias, but two of the four studies did not employ masking and only one study included all randomized participants in the final analyses. The funding source was disclosed by investigators of the largest study (professional society) and not reported by the other three. Due to heterogeneity in lens types evaluated and outcomes reported among the trials, we did not combine d...

A Cross-Sectional Online Survey Identifies Subspecialty Differences in the Management of Pediatric Cataracts Associated with Uveitis

“…This is interesting, as there appears to be a concern that an IOL may trigger intraocular inflammation in uveitic eyes [17]. Our results are consistent with a Cochrane review which concluded that there was uncertainty regarding the optimal IOL type during uveitic cataract surgery [18].…”

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

“…The incidence of PCO is significantly higher with polymethyl metha acrylate IOLs as compared with acrylic IOLs, and PCO rates do not significantly differ between hydrophobic or hydrophilic acrylic IOLs at 6 months' follow-up. 18,19 The lower incidence of PCO in the present study could be explained by the fact most cases had acrylic IOLs implanted within the capsular bag.…”

Controversies in intraocular lens implantation in pediatric uveitis

“…They suggested that a lens with a sharp optic edge had better visual outcomes in uveitic eyes because of reduced incidence of PCO [ 45 ]. A Cochrane review by Leung et al on types of intraocular lenses for cataract surgery in uveitis included four studies with a patient profile of adult uveitic eyes [ 42 , 46 – 49 ]. They concluded that there was uncertainty as to which type of IOL gave best visual and clinical outcomes in uveitic cataract surgery based on existing studies and advocated a multicenter international study.…”