Manual suture less small incision cataract surgery in patients with uveitic cataract

Abstract

Purpose: The purpose of this study is to evaluate the outcome of manual small incision cataract surgery (SICS) in eyes with uveitic cataract.

Setting: Medical college hospital of the subcontinent.

Design: Retrospective case series.

Materials and methods: In this retrospective study, patients who underwent SICS with posterior chamber intraocular lens implantation for uveitic cataract from 2006 to 2009 were evaluated. Patients with less than 3 months follow-up were excluded. Post-operative vision and complications were analyzed.

Results: A total of 54 patients completed the study. The mean age was 52.3 ± 9.3 years. The mean follow-up was 11.53 ± 5.05 months. The mean surgical time was (10.2 ± 3.8 min). Etiological diagnosis was possible in 31.41% (17/54) of patients. There was a statistically significant improvement in vision after surgery (P < 0.001). When uveitis was well-controlled, pre-operative corticosteroids did not change post-operative inflammation (P = 0.796). However, pre-operative corticosteroids were statistically significantly associated to final best corrected visual acuity (BCVA) (P = 0.010).

Conclusion: SICS with posterior chamber intraocular lens implantation is safe in most cataracts due to uveitis and improves BCVA at 6 months. Inflammation should be well-controlled pre-operatively for at least 3 months. Posterior capsule opacification, macular edema and persistent uveitis were the main factors affecting visual outcome. SICS requires minimal instrumentation, surgical time is short and can also be performed in rural clinics and eye-camps, where phacoemulsification machines are unavailable. SICS may be a more practical and cost-effective technique for uveitic cataract, in such circumstances.

Keywords: Best Corrected Visual Acuity; Complicated Cataract; Posterior Capsule Opacification; Small Incision Cataract Surgery; Uveitis.

Figure 1a

Complicated cataract in a patient with Fuch's cyclitis

Figure 1b

Bar diagram showing comparison of pre- and post-operative visual acuity

Figure 1c

A patient with uveitic cataract following small incision cataract surgery

Figure 1d

Additional procedure (neodymium-doped yttrium aluminum garnet laser capsulotomy) done for posterior capsule opacification following surgery in uveitic cataracts

Figure 1e

Macular edema in a patient with persistent uveitis after surgery