Cataract Surgery in Eyes With Uveitis Requires Special Considerations

While rates of intraoperative complications from cataract surgery in eyes with uveitis remain low, managing postoperative care remains a challenge when patients do experience them, according to research published in the American Journal of Ophthalmology. Researchers report a high rate of uveitis relapse and cystoid macular edema (CME).

The study, conducted at a tertiary public hospital setting, evaluated patients with preoperative uveitis who underwent cataract surgery, and evaluated their intraoperative and postoperative complications, as well as predictors of visual outcomes between 2008 and 2020. The primary outcome measures were additional intra-operative procedures, intraoperative and postoperative complications, and post-operative visual outcomes and complications.

The retrospective observational cohort study relied on data from 471 eyes of 371 patients (median age of 59.1 years at time of surgery, 55% women, 45% men). Prior to cataract surgery, patients had a median duration of uveitis of 3.0 years and median period of quiescence of 1.0 years. 

The researchers reported posterior synechiae peel (32.3%) and vision blue (18.1%) as the most common additional procedures. They found that intraoperative complications occurred in 6.8% of eyes.

The team reported that visual acuity was 20/50 or better in 79.7% of eyes by 12 months following surgery and found that the most common postoperative complication was uveitis flare (56.5%). 

With Cox proportional-hazards analysis, the researchers demonstrated that time quiescent was associated with reduced risk of flare (hazard ratio, 0.794;  P =.003). While postoperative CME developed in 9.6% of eyes, the team did not identify any significant predictors of it in the multivariate analysis.

“Overall, cataract surgery in uveitis is safe and effective. While the cataract surgery itself is complex, intraoperative complication rates are low in surgically experienced hands,” concluded the researchers. “Postoperative complications can be unpredictable and occur later than expected, so careful monitoring is important to optimize visual outcomes.”

Limitations of the study included those inherent to retrospective studies and possible overrepresentation of higher risk cases in the setting of a tertiary care center.