This retrospective longitudinal study from Moorfields, London, UK compared uveitis recurrence rates and vision loss in 309 eyes of uveitis patients post cataract surgery to 300 control uveitis patients. Cataract is a common complication associated with uveitis and leads to significant morbidity. Prior to cataract surgery patients at risk of a uveitis flare were given oral prednisolone 40mg/day for two weeks and tapered postoperatively. If oral steroids were contraindicated intravitreal triamcinolone was given at the time of the operation. If steroids were contraindicated no prophylaxis was given. Median follow-up was 6.7 years. Post-surgery, annual rate of uveitis relapses were less than the same period preoperatively (-1.2, 95% CI -2.0 to -0.2, p=0.012). Pseudophakic eyes had a greater risk of vision loss (hazard ratio 2.4, CI 1.4 to 4.0; p<0.001). Cystoid macula oedema (CMO) was the main cause (41.4%) of persistent visual loss in pseudophakic patients and performing cataract surgery in a patient with history of CMO increased the risk of CMO by 2.5 fold. Prophylaxis with steroids decreased risk of visual loss compared to prophylaxis (HR 0.22, CI 0.06 to 0.80, p=0.02). The authors state that the worse visual outcomes in pseudophakic patients are likely attributable to the likelihood of cataract occurring in patients with uveitis being correlated to a more severe form of uveitis in these patients. The authors conclude cataract surgery in patients with preoperative CMO can cause significant visual loss and these patients must have adequate prophylaxis.

Long-term effect of cataract phacoemulsification on the inflammation control and clinical outcome in uveitis patients.
Sharief L, Lightman S, Baltinas J, Tomkins-Netzer O.
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Ivan Yip

Alder Hey Children's Hospital, Liverpool, UK.

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