New insights into cataract surgery in patients with uveitis: A detailed review of the current literature

Abstract

Cataract is a common cause of visual impairment in uveitic eyes. The management of cataract in patients with uveitis is often challenging due to pre-existing ocular comorbidities that may limit the visual outcomes. A meticulous preoperative ophthalmic evaluation is needed to assess the concomitant ocular pathologies with special emphasis on the status of the macula and optic nerve. Preoperative control of inflammation for at least 3 months before surgery is a key prognostic factor for successful surgical outcomes. Perioperative use of systemic and topical corticosteroids along with other immunosuppressive medications is crucial to decrease the risk of postoperative inflammation and cystoid macular edema (CME). Phacoemulsification with intraocular lens implantation is the surgical option of choice for most patients with uveitic cataract. Uveitic cataracts are typically complicated by the presence of posterior synechiae and poor pupil dilation, necessitating manual stretching maneuvers or pupil expansion devices to dilate the pupil intraoperatively. Patients must be closely monitored for postoperative complications such as excessive postoperative inflammation, CME, raised intraocular pressure, hypotony, and other complications. Good outcomes can be achieved in uveitic eyes after cataract extraction with appropriate handling of perioperative inflammation.

Keywords: Cataract; inflammation; phacoemulsification; uveitis.

Figure 1

An 18-year-old female diagnosed as a case of bilateral idiopathic granulomatous panuveitis. (a) Slit lamp photograph of the left eye showing multiple posterior synechiae and posterior subcapsular cataract in a quiet eye with a visual acuity of 20/80. (b) Slit lamp photograph on the 1^st postoperative day after cataract extraction and posterior chamber intraocular lens implantation showing a quiet pseudophakic eye with regular dilated pupil and visual acuity of 20/20

Figure 2

(a) Preoperative photograph of uveitic eye with multiple posterior synechiae in a patient with presumed intraocular tuberculosis with a visual acuity of 20/60. (b and c): Intraoperative use of Kuglen hooks to dilate the pupil and break posterior synechiae

Figure 3

(a): Preoperative photograph of uveitic eye with seclusio pupillae and thin atrophied iris in a patient with Vogt–Koyanagi–Harada with a visual acuity of 20/28.5. (b) Intraoperative use of self-retaining iris hooks placed in a diamond configuration

Figure 4

(a) Preoperative photograph of uveitic eye with 360° broad posterior synechiae and cataract in a patient with granulomatous panuveitis with a visual acuity of 20/200. (b) Intraoperative use of pupil dilating device (Malyugin^® ring)