Posters

3 years of outcomes and complications of cataract phacoemulsification in patients with uveitis

Poster Details

First Author: A.Abbouda ITALY

Co Author(s):    L. Restivo   P. Tortorella   E. Santoro   F. De Marco   M. La Cava  

Abstract Details

Purpose:

The aim of this study was to evaluate the post-cataract outcomes in patients with different type of uveitis. Several studies have just reported complications regarding cataract and uveitis, however, the relationship between the type of uveitis and cataract outcomes has not yet demonstrated. To better know the visual prognosis and ocular complications of ocular surgery in uveitis patients, we followed patients after cataract surgery identifying the different rate and onset of complications among the different type of uveitis.

Setting:

A retrospective non randomized consecutive cohort study was performed at Sapienza University of Rome, Department of Ophthalmology. Patients who were diagnosed of uveitis and underwent phacoemulsification between 2006 to 2009 were identified through surgical records. Inclusion criteria were diagnosis of uveitis, aged 18 or older at the time of cataract extraction. Exclusion criteria were history of penetrating trauma, endophthalmitis, previous intraocular surgery. No-implanted eyes were excluded. All the phacoemulsification and IOL implantation were performed by the same surgeon. 47 patients; 59 eyes respected the study criteria and were analyzed. 26 patients were males (44.1%) and 33 females (55.9%). The median follow-up duration was 42.10±55.80 months (range: 9-396 months). The median age at the time of cataract surgery was 61.44±18.16 years (range: 22.91-81.15 years). 33 patients had anterior uveitis (55.9%), 3 patients had intermediate uveitis (5%), 10 posterior uveitis (16.9%), and 13 panuveitis (22%).

Methods:

The data collected for each patient were age, time of uveitis onset, period of uveitis inactivity before surgery. Cataract was reported according LOCS III classification. Intraoperative complications such as posterior capsule rupture, using of iris hook and anterior vitrectomy were reported. Long term complications such as macular edema, posterior capsule opacification (PCO), hypotony, elevated intraocular pressure (IOP) were reported. Best corrected visual acuity (BCVA) was recorded at preoperative time and after 1-3 months of surgery and at the end of follow-up. Incidence rate was calculated as the number of events or complications divided by the number of eyes at risk during the year (EY). All the patients followed this treatment: three days before surgery, steroid therapy was introduced or increased to 1/2 mg/kg/day in patients presenting an autoimmune uveitis. In Herpetic uveitis, systemic antiviral treatment was introduced on the day of surgery. No additional therapy was given to Fuchs heterochromic cyclitis. Steroid therapy was progressively tapered or increased after surgery according to post-operative inflammation. Topical steroids (0.1% dexamethasone phosphate) were applied 6 times/day during the first post-operative day and were progressively reduced according to the level of ocular inflammation. All data were tabulated and analyzed using statitical package SPSS .

Results:

In 39 eyes was implanted Acrysof® Alcon, 14 eyes Tecnis® ZCB00 Abbot, 6 eyes VA60BB Hoya. No statistic significant difference was found among these lenses and final BCVA (p=0.64) and incidence of PCO (p=0.65; Kruskal Wallis). The median duration of uveitis inactivity before surgery was 21.14±11.56 months. The mean pre-operative BCVA at the pre-operative visit was 0.21±0.20 decimal, at 1 month of cataract surgery 0.81±0.29 decimal; at 3 months 0.82±0.29 decimal and at the end of follow up 0.75±0.32 decimal (p=0.00; Friedman test). The intraoperative complications included 1 case of posterior capsule rupture with anterior vitrectomy and in 18 eyes (30.5%) iris hook were used. Among the long term complications the incidence of macular edema was 0.02 EY. The median time of macular edema onset after surgery is 51.19±16.9 months (95% CI 50.39-51.80). The incidence of PCO was 0.07 EY. The median time of PCO onset after surgery was different among type of uveitis. Hypotony and elevated IOP were detected in anterior uveitis group. The incidence of hypotony was 0.02 EY. The median time of onset was 13.2±12.74 months (95% CI 0-43.3). The incidence of Elevated IOP was 0.04 EY. The median time of onset was 2.77±3.27 (95% CI 0-6.20).

Conclusions:

This study describes the long term outcomes and complications of cataract surgery in patients with uveitis. When inflammation in eyes with uveitis is undercontrol, phacoemulsification and implantation of IOL is safe effective and well tolerated. Eyes with well-controlled uveitis obtain similar outcomes to normal eyes. The incidence of macular edema in the group analyzed is quite similar to normal eyes. Four case of macular edema was detected in anterior uveitis and 2 cases in panuveitis (p=0.3; Mantel Cox). In the group of anterior uveitis, the complication related to IOP was clinically more common compared to the other groups. No cases of hypotony and elevated IOP were described in the other groups. No statistic significant difference was found among PCO and type of uveitis. In anterior uveitis, a median PCO onset was 12.32±17.59 months (95% CI 0.41-24.04), in posterior and panuveitis was respectively 25.34±10.13 (95% CI 0-116.4) and 22.29±12.21 (95% CI 0-131.90). No significant statistical difference was found (p=0.4; Mantel Cox) but clinically we observed an early PCO in the anterior uveitis groups. The visual results showed a good outcome. The BCVA was 0.75±0.32 decimal after a median follow up of 42.10±55.80 months. No statistic significant association was found between visual acuity and postoperative complications. Significant association was found to visual acuity lower than 0.5 decimal and the diagnosis of panuveitis (p=0.04). In spite of the expected postoperative complications, the incidence of worsened vision is very small. The great majority of patients regain and retain a high visual outcome. FINANCIAL INTEREST: NONE