Cataract patients with uveitis may develop uveitis flare and cystoid macular oedema after surgery

A study was done to determine the outcomes of cataract surgery in eyes with uveitis, including the rates of intra-operative and post-operative complications and predictors of visual outcomes.

It is a retrospective observational cohort study. It was conducted in a tertiary public hospital setting in Auckland, New Zealand, between 2008 and 2020. They selected subjects who underwent cataract surgery following a diagnosis of uveitis. The major study outcomes were additional intra-operative procedures; intra-operative and post-operative complications; postoperative visual outcomes and complications.

Results:

• 471 eyes of 371 subjects were included. The median duration of uveitis prior to cataract surgery was 3.0 years and the median period of quiescence prior to surgery was 1.0 years
• Additional procedures (posterior synechiae peel (32.3%), vision blue (18.1%)) were common. Intra-operative complications occurred in 32 eyes (6.8%).
• Consultants were the primary surgeons in the majority (82.5%) of operations.
• By 12 months, visual acuity was 20/50 or better in 248 eyes (79.7%).
• The most common post-operative complication was uveitis flare, occurring in 56.5%.
• On Cox proportional hazards analysis, time quiescent was associated with reduced risk of flare
• Post-operative cystoid macular edema (CME) developed in 45 eyes (9.6%), with no significant predictors identified on multivariate analysis.

Thus, cataract surgery in uveitis is complex. In the hands of the surgically experienced, rates of intra-operative complications are low. The primary challenge is managing post-operative care as we report a high rate of uveitis relapse and CME. Careful monitoring is important as complications can be unpredictable and occur later than expected.

Reference:

Haya Husam Al-Ani, Joanne Lesley Sims, Rachael Louise Niederer. Cataract Surgery in Uveitis: Risk Factors, Outcomes and Complications. American Journal of Ophthalmology. Published: August 20, 2022 DOI: https://doi.org/10.1016/j.ajo.2022.08.014

Keywords:

Cataract, patients, uveitis, develop, uveitis, flare, cystoid, macular, edema, surgery, American Journal of Ophthalmology, Haya Husam Al-Ani, Joanne Lesley Sims, Rachael Louise Niederer