Viral Anterior Uveitis Does Not Preclude Cataract Surgery Success

Close-up of the eye of an elderly patient, showing acute anterior uveitis. The sclera (white of the eye) is bloodshot. Uveitis is an inflammation of the uvea of the eye (colored iris, lens muscles, blood vessels supplying the retina). Usually it is an autoimmune disorder in which the immune system attacks it’s own body, although uveitis may be caused by an infection.
Cataract surgery in patients with CMV anterior uveitis leads to significantly improved corrected distance visual acuity (CDVA) in 73% of patients, a study says.

Cytomegalovirus (CMV) anterior uveitis does not prevent patients undergoing cataract surgery from achieving significant corrected distance visual acuity (CDVA) improvements, according to a Journal of Cataract and Refractive Surgery report.  The report also shows that preoperative topical ganciclovir 0.15% and intraoperative intracameral corticosteroid seem to maximize final visual outcomes.

Researchers looked at the history, clinical characteristics, CDVA, medications, and complications of CMV anterior uveitis of patients undergoing surgery between 2010 and 2020 at a hospital in Hong Kong. The study includes 26 eyes of 26 patients undergoing phacoemulsification with a median disease duration of 4.8 years and a median quiescent period before surgery of 2.3 years. Results show that the median CDVA improved from 20/100 (IQR 20/200-20/50) before surgery to 20/30 (IQR 20/40-20/25) at 1 year and 20/35 (IQR 20/50-20/30) at the last follow-up at a median of 4.9 years after surgery, respectively (P <.001). While the majority of eyes with CMV anterior uveitis achieved good visual outcomes following cataract surgery, 75% of those with a final corrected visual acuity worse than 20/40 were attributed to underlying uveitic glaucoma.

“CDVA improved in 19 eyes (73.1%) and was ≥20/40 in 18 eyes (69.2 %),” according to the study. “In the multivariate regression model, preoperative use of topical 0.15% ganciclovir (β 0.33, 95% CI 0.17-0.48, P <.001) and adjunctive intraoperative intracameral dexamethasone 0.4mg (β 0.19, 95% CI 0.01-0.36, P =.043) were associated with a better final CDVA. Loss of CDVA and poor postoperative CDVA visual acuity were mostly attributed to uveitic glaucoma, but preoperative glaucoma or the number of antiglaucoma medications did not affect final CDVA.” 

Limitations of this study include the small sample size, retrospective nature, and lack of diversity among participants. Further, several surgeons performed the phacoemulsification with the decision for adjunct intraoperative steroid was at the surgeon’s discretion. Despite these limitations, this study highlights the need for prospective studies with larger sample sizes. The findings provide hope for patients and surgeons looking toward cataract surgery in eyes with CMV anterior uveitis.


Wan K, Liu K, Lam N, Chow V. Outcomes and prognostic factors of cataract surgery in cytomegalovirus related anterior uveitisJ Cataract Refract Surg. Published online March 16, 2022. doi:10.1097/j.jcrs.0000000000000929