Posters

Case report: effectiveness of intensive perioperative corticosteroid therapy in severe ulcerative colitis-associated uveitis undergoing cataract surgery

Poster Details

First Author: A.Lula ALBANIA

Co Author(s):    R. Bulaj                    

Abstract Details

Purpose:

To report that post-operative outcome of cataract surgery in patients with severe Ulcerative Colitis (UC)-associated uveitis with presence of a pupillary membrane could have excellent results if adequate peri-operative corticosteroid therapy would be applied. Cataract is a common complication of any pattern of uveitis (affecting 6% of patients with active Ulcerative Colitis -associated uveitis) with an increased risk of complications and lower visual acuity outcomes; additionally, the presence of a pupillary membrane increases the rate of intra-operative complications. However, control of exacerbations with intensive peri-operative corticosteroid regimens indicates that excellent results can be achieved even in severe cases.

Setting:

University Hospital Centre “Mother Theresa”, Department of Ophthalmology, Tirana, Albania

Methods:

This is a case report of a 43 year old woman diagnosed with severe UC-associated uveitis who underwent cataract surgery with IOL implantation in the LE after aggressive corticosteroid therapy. The diagnosis of UC-associated uveitis was based on the following findings/examinations: a. results of colonoscopy (presence of crypt abscesses and pseudo-polyps), b. Mucocutaneous lesions (pyoderma gangrenosum), c. Autoimmune hepatitis, d. Visual Acuity (LVA) 6/60, e. +3 AC cells, f. posterior synechia, g. ciliary injection, h. raised IOP (34mmHg). Treatment of AAU consisted in the pre-operative administration of 0.7mg/kg/day Prednisolone, followed by intra-operative Triamcinolone and post-operative topical administration of Dexamethasone.

Results:

Cataract surgery with synechiolysis and removal of the pupillary fibrinoid membrane following the application of an aggressive corticosteroid regimen resulted in a significant improvement of BCVA (LVA 6/12) and reduction of IOP to normal values (16mmHg). Intensive corticosteroid therapy showed extremely effective results, achieving excellent control of inflammation, reducing the risk of post-operative cystoid macular oedema (CMO) and minimizing the risk of exacerbation of uveitis. Posterior capsular opacification (PCO) was treated with YAG-laser capsulotomy 5 months after surgery, while mild post-operative steroid-induced ocular hypertension was treated with IOP lowering medications (prostaglandin analogues).

Conclusions:

Although there is no standard corticosteroid regimen for the treatment of Ulcerative Colitis-associated uveitis undergoing cataract surgery with IOL implantation, intensive corticosteroid therapy (immune-suppressive treatment) should be considered as a very effective alternative in improving the post-operative outcome and reducing the risk of inflammation-related complications. However, long-term safety is still unknown, especially in severe and complicated cases, indicating that close observation and frequent follow-ups of patients with this systemic condition undergoing cataract surgery is required to reduce the risk of visual impairment and prevent future exacerbations of inflammatory activity.

Financial Disclosure:

None