Outcome of phacoemulsification in patients with uveitis

¹ Moorfields Eye Hospital, United Kingdom
² St. Vincent's Hospital and University of New South Wales, Australia
³ Whipps Cross University Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: s.lightman{at}ucl.ac.uk.

Accepted 2 January 2007

	Abstract

Purpose: To examine the visual outcome and identify risk factors for developing postoperative uveitis, macular oedema and Nd:YAG capsulotomy after phacoemulsification 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 first 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. The cumulative probability of doubling of the visual angle was 52% over 6 years of follow-up and this occurred 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 visual acuity after phacoemulsification but an increasing rate of visual loss occurs in those with pre-existent macular or optic nerve lesions. Identifying patients at risk of postoperative complications should help in patient counselling and to pre-empt these complications by using preoperative prophylactic corticosteroids, careful IOL selection and postoperative intensive corticosteroids.

Keywords: cataract, intraocular lens, outcome, phacoemulsification, uveitis