Posters

Cataract surgery in uveitis

Poster Details

First Author: V. Cerovic CROATIA

Co Author(s):    N. Gabric   A. Barisic   M. Ratkovic              

Abstract Details

Purpose:

Cataract develops in patients with uveitis because of the uveitis itself and because of the steroids which are cornerstone in treating uveitis. Cataract developing in an eye with a history of chronic or recurrent uveitis has historically been called cataracta complicata, and, indeed, the uveitic cataract is complicated. It is complicated both from the standpoint of technical aspects of the surgery itself (limited access secondary to posterior synechiae, pupillary membrane, and pupillary sphincter sclerosis, iris delicacy and vascular abnormalities, and pre-existing glaucoma), also because of the high likelihood of an exuberant postoperative inflammatory response which can ruin the surgical outcome.

Setting:

We will show you few video presentations of cataract surgery in uveitic eyes. All patients were operated by one surgeon in Svjetlost Eye Hospital, Zagreb in last two years.

Methods:

The most important steps before surgery is inflammation control, surgery timing and assessing cataract degree as well as aftersurgery prognostication. For most uveitis, three-months inflammation free period is considered adequate for planning cataract surgery. Many of these eyes with prior anterior uveitis have posterior synechiae withadherent iris to the anterior lens capsule. The synechiae as well as pupillary membrane limit pupil dilatation and limit access to the cataract. The membrane and synechiae can be dissected with forceps, blunt spatula and viscoelastic solution. The pupil can than be expanded mechanically held in the position with iris hooks or other expansion devices.

Results:

Improvement in microsurgical techniques have also improved the results. The postoperative period following cataract surgery in uveitic eyes can be potentionaly stormy. Exacerbation of inflammation, membrane formation, elevation of intraocular pressure, formation of synechiae, greater incidence of the posterior capsular opacification and macular changes in the form of cystoid macular edema ar not uncommon. All patients need to be on frequent topical steroids and non-steroidal anti-inflammatory agents in addition to oral therapy which is started preoperatively in selected cases. In addition, topical mydriatics are added to keep the pupil mobile and prevent synachiae formations.

Conclusions:

It is possible to achieve successful visual outcomes following cataract surgery in uveitis with the modern day cataract surgery. The predictability has improved mainly because of a higher level of understanding of the uveitic disease among clinicians. Preoprative factors include proper patient selection and counseling and preoprative control of inflammation.

Financial Disclosure:

NONE