Uveitic cataract surgery: analysis of data of patients in a tertiary academic referral centre

Session Details

Session Title: Cataract Surgery: Special Cases

Session Date/Time: Tuesday 17/09/2019 | 08:30-10:30

Paper Time: 09:36

Venue: Free Paper Forum: Podium 2

First Author: : C.Kalogeropoulos GREECE

Co Author(s): :    D. Kalogeropoulos   M. Stefaniotou   C. Pappa   A. Christodoulou   K. Malamos   I. Asproudis              

Abstract Details

Purpose:

The analysis of various parameters including the causes and severity of intraocular inflammation, inducing cataract, in order to evaluate the safety and postoperative results of cataract surgery in patients with uveitis and also the contribution of several surgical techniques and perioperative management to prevent and decrease the complications rates either during surgery or postoperatively. In addition, the study aims to the detection of the gradual improvement of surgical and visual outcome scores during a long period of surgical experience.

Setting:

Ocular Inflammation Service, Department of Ophthalmology, University General Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece.

Methods:

The data of patients with history of uveitis, who underwent cataract surgery (as a complication of uveitis) between 1991 and 2018 were analyzed. Patients were included in the specific protocol of Ocular Inflammation Service for complete description, diagnostic procedure and management of uveitis and its complications. Concerning uveitic cataract surgery the following parameters were taken into consideration: 1) Cause of uveitis, 2) Severity and course of uveitis, 3) Complications of uveitis before surgery, 4) Impact of perioperative care to the outcome, 5) Impact of surgical techniques, intraocular lens type and complications during surgery to the outcome, 6) Postoperative complications management.

Results:

643 patients (685 eyes) were included in the study (87% of cases were operated with phacoemulsification). The cause of uveitis was an infectious agent in 154 cases, an autoimmune disease was known in 441 and in 90 cases cause remained unrevealed. Severity of ocular inflammation, irrespectively of the cause of uveitis, was related to the operative difficulties (68% of eyes). Chronicity and multiple recurrences, resulting in preoperative cumulative damages (58% of eyes), led to a less favorable visual outcome. Postoperative complications rates, influencing significantly the visual outcome, were decreased from 42% before the year 2000 to 27% after year 2010.

Conclusions:

The outcome of uveitic cataract surgery is multifactorial. Chronicity, multiple recurrences and severity of uveitis are crucial factors influencing the safety and complications and also visual outcome of uveitic cataract surgery. Visual outcome had a strong correlation with the postoperative complications of uveitic cataract surgery, but also with the preoperatively established cumulative damages due to inflammation. However, new surgical instrumentation concerning refinement of phacoemulsification, advanced surgical techniques, new medications and updated therapeutic protocols (including those for perioperative care), improvements of intraocular lenses and accumulative surgical experience resulted in significantly better outcome of uveitis cataract surgery, especially after the year 2010.

Financial Disclosure:

None