This work evaluates the role of combined phacoemulsification and vitrectomy surgery in the management of cataract associated with noninfectious uveitis.
Methods:
A retrospective chart review was conducted of all patients aged 7 years or older who underwent a combined surgical approach from 2005 to 2018.
Results:
Eighty-five eyes of 67 patients were included in the study; 10.7% of eyes had a best-corrected visual acuity (BCVA) of 20/40 or better at time of surgery. At 1-year follow-up, 63.4% of eyes had a BCVA 20/40 or better and 7.6% had a BCVA of 20/200 or worse. There was an overall decrease in cystoid macular edema after surgery compared with preoperatively (47.6% vs 34.5% presurgery and postsurgery, respectively). Complete inflammatory disease remission off immunomodulatory therapy and systemic steroids was achieved in 21.1% of patients.
Conclusions:
A combined surgical approach is effective in visual rehabilitation in patients with uveitic cataracts and may promote inflammatory disease remission specifically in intermediate uveitis.
NussenblattRB. The natural history of uveitis. Int Ophthalmol. 1990;14(5-6):303–308. doi:10.1007/BF00163549
2.
EdelstenC. An evaluation of baseline risk factors predicting severity in juvenile idiopathic arthritis associated uveitis and other chronic anterior uveitis in early childhood. Br J Ophthalmol. 2002;86(1):51–56. doi:10.1136/bjo.86.1.51
3.
ConstantinTFoeldvariIAntonJ, et al.Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative. Ann Rheum Dis. 2018;77(8):1107–1117. doi:10.1136/annrheumdis-2018-213131
4.
CannMRamananAVCrawfordA, et al.Outcomes of non-infectious paediatric uveitis in the era of biologic therapy. Pediatr Rheumatol Online J. 2018;16(1):51. doi:10.1186/s12969-018-0266-5
5.
SenHNDryeLTGoldsteinDA, et al.; Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group. Hypotony in patients with uveitis: the Multicenter Uveitis Steroid Treatment (MUST) trial. Ocul Immunol Inflamm.2012;20(2):104–112. doi:10.3109/09273948.2011.647228
6.
JiYHuKLiC, et al.Outcome and prognostic factors of phacoemulsification cataract surgery in Vogt-Koyanagi-Harada uveitis. Am J Ophthalmol. 2018;196:121–128. doi:10.1016/j.ajo.2018.08.041
7.
MehtaSLintonMMKempenJH. Outcomes of cataract surgery in patients with uveitis: a systematic review and meta-analysis. Am J Ophthalmol. 2014;158(4):676–692. doi:10.1016/j.ajo.2014.06.018
8.
DiamondJGKaplanHJ. Lensectomy and vitrectomy for complicated cataract secondary to uveitis. Arch Ophthalmol. 1978;96(10):1798–1804. doi:10.1001/archopht.1978.03910060310002
9.
SecchiAG. Cataract surgery in exudative uveitis: effectiveness of total lens removal, anterior vitrectomy, and scleral fixation of PC IOLS. Eur J Ophthalmol. 2008;18(2):220–225. doi:10.1177/112067210801800209
10.
TrittibachPKoernerFSarraG-MGarwegJG. Vitrectomy for juvenile uveitis: prognostic factors for the long-term functional outcome. Eye (Lond). 2006;20(2):184–190. doi:10.1038/sj.eye.6701845
11.
BeckerMDavisJ. Vitrectomy in the treatment of uveitis. Am J Ophthalmol. 2005;140(6):1096–1105. doi:10.1016/j.ajo.2005.07.017
12.
HenryCRBeckerMDYangYDavisJL. Pars plana vitrectomy for the treatment of uveitis. Am J Ophthalmol. 2018;190:142–149. doi:10.1016/j.ajo.2018.03.031
13.
KoenigSBMielerWFHanDPAbramsGW. Combined phacoemulsification, pars plana vitrectomy, and posterior chamber intraocular lens insertion. Arch Ophthalmol. 1992;110(8):1101–1104. doi:10.1001/archopht.1992.01080200081029
14.
SoheilianMMirdehghanSAPeymanGA. Sutureless combined 25-gauge vitrectomy, phacoemulsification, and posterior chamber intraocular lens implantation for management of uveitic cataract associated with posterior segment disease. Retina. 2008;28(7):941–946. doi:10.1097/IAE.0b013e31816ed5c7
15.
VillegasVMGoldASLatiffAWildnerACEhliesFJMurrayTG. Phacovitrectomy. Dev Ophthalmol. 2014;54:102–107. doi:10.1159/000360455
PhatakSLowderCPavesioC. Controversies in intraocular lens implantation in pediatric uveitis. J Ophthalmic Inflamm Infect. 2016;6(1):12. doi:10.1186/s12348-016-0079-y
18.
JabsDANussenblattRBRosenbaumJT; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol. 2005;140(3):509–516. doi:10.1016/j.ajo.2005.03.057
19.
HarrisPATaylorRThielkeRPayneJGonzalezNCondeJG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381. doi:10.1016/j.jbi.2008.08.010
20.
SungVCTBartonK. Management of inflammatory glaucomas. Curr Opin Ophthalmol. 2004;15(2):136–140. doi:10.1097/00055735-200404000-00014
21.
MoraPGonzalesSGhirardiniS, et al.Perioperative prophylaxis to prevent recurrence following cataract surgery in uveitic patients: a two-centre, prospective, randomized trial. Acta Ophthalmol. 2016;94(6): e390–e394. doi:10.1111/aos.12955
22.
BélairM-LKimSJThorneJE, et al.Incidence of cystoid macular edema after cataract surgery in patients with and without uveitis using optical coherence tomography. Am J Ophthalmol. 2009;148(1):128–135.e2. doi:10.1016/j.ajo.2009.02.029
23.
NagataKMaruyamaKUnoK, et al.Simultaneous analysis of multiple cytokines in the vitreous of patients with sarcoid uveitis. Invest Ophthalmol Vis Sci. 2012;53(7):3827–3833. doi:10.1167/iovs.11-9244
24.
PerezVLPapaliodisGNChuDAnzaarFChristenWFosterCS. Elevated levels of interleukin 6 in the vitreous fluid of patients with pars planitis and posterior uveitis: the Massachusetts Eye & Ear experience and review of previous studies. Ocul Immunol Inflamm. 2004;12(3):205–214. doi:10.1080/092739490500282
25.
CaspiRR. A look at autoimmunity and inflammation in the eye. J Clin Invest. 2010;120(9):3073–3083. doi:10.1172/JCI42440
26.
StreileinJW. Anterior chamber associated immune deviation: the privilege of immunity in the eye. Surv Ophthalmol. 1990;35(1):67–73. doi:10.1016/0039-6257(90)90048-Z
27.
KempenJHGewailyDYNewcombCW, et al.Remission of intermediate uveitis: incidence and predictive factors. Am J Ophthalmol. 2016;164:110–117. doi:10.1016/j.ajo.2015.12.034
28.
SohnEHChaonBCJabsDAFolkJC. Peripheral cryoablation for treatment of active pars planitis: long-term outcomes of a retrospective study. Am J Ophthalmol. 2016;162:35–42.e2. doi:10.1016/j.ajo.2015.11.009
29.
AyusoVKvan de WinkelELRothovaAde BoerJH. Relapse rate of uveitis post-methotrexate treatment in juvenile idiopathic arthritis. Am J Ophthalmol. 2011;151(2):217–222. doi:10.1016/j.ajo.2010.08.021
30.
FoellDFroschMSchulze zur WieschAVoglTSorgCRothJ. Methotrexate treatment in juvenile idiopathic arthritis: when is the right time to stop?Ann Rheum Dis. 2004;63(2):206–208. doi:10.1136/ard.2003.005686
31.
GuptaGRamJGuptaV, et al.Efficacy of intravitreal dexamethasone implant in patients of uveitis undergoing cataract surgery. Ocul Immunol Inflamm. 2019;27(8):1330–1338. doi:10.1080/09273948.2018.1524498
