Outcome of Phacoemulsification in Patients with Uveitis

¹ Moorfields Eye Hospital, United Kingdom
² St. Vincents Clinic, Australia
³ Whipp's Cross Hospital, United Kingdom
⁴ Royal Prince Alfred & St Vincent Hospitals, Australia

^* To whom correspondence should be addressed. E-mail: m.elgohary{at}doctors.org.uk.

Accepted 30 November 2006

	Abstract

Purpose: To examine the visual outcome and identify risk factors for developing postoperative uveitis, macular oedema and Nd:YAG capsulotomy after phacoemulsification (PE) and intraocular lens (IOL) implantation in patients with uveitis.

Method: This is a retrospective review of the medical records of 101 eyes of 101 patients. One eye was randomly selected for inclusion in patients who had bilateral surgery. Patients with juvenile arthritis, kerato-uveitis and lymphoma-associated uveitis were excluded.

Results: At the postoperative and final visits, visual acuity was significantly better (p<0.001) and 64.4% and 71.3% of patients, respectively, achieved >=2 lines of visual improvement. Doubling of the visual angle occurred in 52% of patients over 6 years of follow- up and at a higher rate in the presence of preoperative retinal or optic nerve lesions [HR=4.49; 95% confidence interval (CI) (1.41 to 14.29)]. Within 3 months postoperatively, uveitis was more likely in female patients [OR=6.21 (1.41, 27.43)] and in the presence of significant intra-operative posterior synechiae [OR=8.43 (1.09, 65.41)]; and macular oedema was more likely in patients who developed postoperative uveitis [OR=7.45 (1.63, 34.16)]. Nd:YAG capsulotomy occurred at a higher rate in patients aged 55 years or younger [HR=2.28; 95% CI (1.06, 4.93)] and in those with hydrogel IOLs [HR=3.71 (1.04, 13.20)] and at a lower rate in patients who had prophylactic systemic corticosteroids [HR=0.25 (0.11, 0.59)], with plate-haptic silicone IOLs [HR=0.23 (0.08, 0.64)] and 3-piece silicone IOLs [HR=0.19 (0.05, 0.74)] in comparison with PMMA IOLs.

Conclusion: The majority of patients with uveitis achieve improvement of their visual acuity after phacoemulsification but an increasing rate of doubling of the visual angle occurs in patients with pre-existent macular or optic nerve lesions. The use of prophylactic steroids, careful IOL selection and postoperative intensive steroids in patients at risk should help reduce postoperative complications and plan their follow- up.

Keywords: cataract, complication, phacoemulsification, uveitis, vision