This is a systematic, evidence-based literature review and meta-analysis, looking at the visual outcomes (vision 20/40 or better) of cataract surgery in uveitic eyes. The authors searched MEDLINE, EMBASE, CINHAL and CENTRAL, including English language and human studies only. They excluded conference abstracts, unpublished data, very small case-series, and studies reporting on combined procedures and intra-capsular cataracts extraction. Eighty-nine articles met the eligibility criteria out of 2815 articles. The authors standardised the results by determining the ratio of uveitic eyes in each study that achieved vision 20/40 or better after cataract surgery (95% confidence intervals). They found that 71% of eyes with quiet / mostly quiet uveitis of more than two months, at the time of surgery with intraocular lens implant (IOL), achieved the desired visual outcome of 20/40 or better postoperatively, versus 52% that were left aphakic. This was the case in 68% after phacoemulsification, 72% after extracapsular cataract extraction and 40% after pars plana lensectomy. Eyes with acrylic IOL or heparin-surface modified (HSM) polymethylmethacrylate had better outcomes (72%) than eyes with silicone IOLs (30%) or non-HSM polymethylmethacrylate (62%).The best visual outcome was achieved by patients with Fuchs heterochromic uveitis (92%), versus uveitis due to JIA (65%), intermediate uveitis (69%) or Behcet’s disease (36%). Studies regarding rarer uveitides like posterior uveitis, Vogt-Koyanagi-Harada syndrome (VKH), sarcoidosis and sympathetic ophthalmia were scarce and overall did worse with vision 20/40 or better achieved only in 40-49%. The authors highlight the limitations of their review, such as publication bias, the difficulty to adjust for various confounding attributes simultaneously (to account for prognostic characteristics), their use of a visual acuity metric, which evaluated the chance of gaining a visual acuity outcome rather than a frank visual improvement and the variability of the reported time-points, which overall were short-term. They conclude that more research is required to provide better evidence on which surgeons can confidently base their management of uveitic cataracts, with an emphasis on the individual clinical entities.

Outcomes of cataract surgery in patients with uveitis: a systematic review and meta-analysis.
Mehta S, Linton MM, Kempen J.
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Efrosini Papagiannuli

Birmingham and Midland Eye Centre, Birmingham, UK

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