Differential diagnosis of postoperative acute uveitis

Session Details

Session Title: Cataract Surgery Complications

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 10:09

Venue: Boulevard A

First Author: : A.Zilfyan ARMENIA

Co Author(s): :                  

Abstract Details

Purpose:

Differential diagnosis of postoperative complications at complicated cataracts is rather difficult, because clear-cut criteria are lacking, while there is an identical clinical symptomatology. The observation group made 600 patients with senile and complicated cataracts who previously underwent micro-coaxial phacoemulsification. Patients were arranged into 3 study groups: Group 1 made patients with senile cataracts (200 eyes), Group 2 – patients with complicated cataracts on the background of primary open-angle II-III degree glaucoma (200 eyes); Group 3 – patients with complicated cataracts on the background of type II diabetes mellitus (200 eyes). Based on our own clinical investigation, a summarized of informative criteria for differential diagnosis between endophthalmitis, toxic anterior segment syndrome and autoimmune aseptic postoperative uveitis is proposed. Using the specified practicing cataract surgeon can differentiate the precise type of inflammatory process observed at complicated cataracts in a postoperative period.

Setting:

Zilfyan A.A.Scientific-Research Center, Yerevan State Medical University, Yerevan, Armenia 2 “Shengаvit” Medical Center, Yerevan, Armenia 3 “Laser Vision Correction Cente No financial interest

Methods:

The observed group made 600 patients with senile and complicated cataracts who underwent micro-coaxial phacoemulsification through 2.2 mm incision; the surgery intervention was done. The degree of lens opacity was evaluated using both Buratto classification. The study cohort was arranged into three groups. The first group embraced patients with senile cataract (200 eyes). The second group made patients with complicated cataract on the background of the I-II degree primary open-angle glaucoma (200 eyes). The third group involved patients with complicated cataract on the background of type 2 diabetes mellitus (200 eyes). Irrespective of cataract degree and stage, all patients underwent micro-coaxial phacoemulsification with implantation of hydrophobic acrylic posterior chamber intraocular lens. No serious intra-operative complications were recorded by us. There were no cases of hemorrhages, posterior chamber ruptures, etc. In some cases of different degree lens subluxation we implanted capsular rings of different diameters and, if mydriasis was insufficient, pupil rings of Malyugin were used. The operation was performed by the same surgeon. The average duration of surgical intervention was 10 minutes.

Results:

In 2 patients of the first study group we recorded cases of acute endophthalmitis with hypopyon and loss visual functions. On the second day after surgery intravitreal injection of antibiotic vancomicin was done. The signs of acute endophthalmitis were coped by the end of the first week. Different degrees of TASS displays expressiveness were recorded by us in 3 cases. We managed to avoid severe complications through the increased number of steroids instillation, prescription of B-blockers and lubricants. In 9 patients of the second group the autoimmune aseptic inflammatory process was observed: iridociclitis with the presence of inflammatory cells in the anterior chamber (+2, +3) and fibrin exudation. In 8 cases moderately expressed inflammatory reaction originated in the third group; autoimmune aseptic iridocyclitis with the presence of inflammatory cells (from +1 to +2) in the anterior chamber was observed. In 2 patients of the second and in 1 patient of the third group TASS developed. Proceeding from the generally known signs, which are characteristic to the acute endophthalmitis and TASS, as well as on the base of our earlier performed studies on aseptic uveitis development, we propose informative criteria for differential diagnosis between the above-mentioned pathological states of the eye.

Conclusions:

The proposed Table is grounded on identification of the main clinical symptoms, which are characteristic for each of the specified pathology states. Using the Table a practical cataract surgeon will be enabled to differentiate the precise type of inflammatory process that originates in the postoperative course of complicated cataracts. The symptomatology of the studied eye diseases presented in the Table will mostly facilitate in conducting the modern adequate treatment of acute endophthalmitis, TASS and autoimmune aseptic anterior uveitis.

Financial Interest:

NONE