Surgical management in patient with uveitis

Abstract

Surgery in the management of uveitis can be divided based on indication: either for therapeutic or can be for diagnostic purposes or to manage complications. The commonest indications include: Visual rehabilitation: surgery for removal of cataract, band keratopathy, corneal scars, pupillary membranes, removal of dense vitreous membranes, management of complications: anti-glaucoma surgery, vitreous hemorrhage, retinal detachment and chronic hypotony and diagnostic: aqueous tap, vitreous biopsy, tissue biopsy (iris, choroid). In this review, we shall describe the surgical technique for visual rehabilitation and for management of complications.

Figure 1

Slit lamp photograph shows a patient with chronic idiopathic panuveitis with a white cataract and extensive posterior synechiae and neo-vascularization on the anterior lens capsule

Figure 2a

Complicated cataract in a patient with idiopathic anterior uveitis with posterior synechia and a quiet eye at the time of surgery

Figure 2b

Post-operative outcome after phacoemulsification

Figure 3a

Pre-operative (a) photograph of a patient with Fuch's uveitic syndrome, showing diffuse, large keratic precipitates

Figure 3b

Post-operative photograph shows recurrence of these precipitates as stellate deposits on the intraocular lens

Figure 4

Optic capture of the intraocular lens, which was implanted in the sulcus and pupillary membranes in a 35-year-old female patient with intermediate uveitis who underwent surgery 5 years ago

Figure 5

(a and b) Slit lamp photograph of a patient with chronic uveitis and secondary glaucoma who underwent Ahmed glaucoma valve implant, showing the valve well positioned in the anterior chamber, diffuse (a) and slit illumination (b)

Figure 6

Intra-operative photograph showing single port diagnostic vitrectomy using 23 G vitrectomy cutter with 2 ml disposable syringe connected to suction tubing