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Outcome of phacoemulsification in patients with uveitis
  1. M A Elgohary1,2,
  2. P J McCluskey3,
  3. H M A Towler4,
  4. N Okhravi1,
  5. R P Singh3,
  6. R Obikpo4,
  7. S S Lightman1
  1. 1Moorfields Eye Hospital, London, UK
  2. 2Tanta University Ophthalmology Hospital, Tanta, Egypt
  3. 3Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  4. 4Whipps Cross University Hospital, London, UK
  1. Correspondence to: Professor S S Lightman Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK; s.lightman{at}ucl.ac.uk

Abstract

Aims: To examine the visual outcome and identify risk factors for postoperative uveitis, macular oedema and neodymium-doped yttrium aluminium garnet (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, keratouveitis 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, had achieved ⩾2 Snellen’s 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 (95% CI) 4.49 (1.41 to 14.29)). Within 3 months after operation, uveitis was more likely to develop in female patients (OR (95% CI) 6.21 (1.41 to 27.43)) and in the presence of significant intraoperative posterior synechiae (OR (95% CI) 8.43 (1.09 to 65.41)); macular oedema was more likely to develop in patients who developed postoperative uveitis (OR (95% CI) 7.45 (1.63 to 34.16)). Nd:YAG capsulotomy occurred at a higher rate in patients aged ⩽55 years (HR (95% CI) 2.28 (1.06, 4.93)) and in those with hydrogel IOLs (HR (95% CI) 3.71 (1.04 to 13.20)), and occurred at a lower rate in patients who had prophylactic systemic corticosteroids (HR (95% CI) 0.25 (0.11 to 0.59)), with plate-haptic silicone IOLs (HR (95% CI) 0.23 (0.08 to 0.64)) and three-piece silicone IOLs (HR (95% CI) 0.19 (0.05 to 0.74)) in comparison to those with polymethylmethacrylate IOLs.

Conclusion: Most patients with uveitis achieve improved visual acuity after phacoemulsification, but an increasing rate of visual loss is observed in those with pre-existent macular or optic nerve lesions. Identifying patients who are 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.

  • BCVA, best-corrected visual acuity
  • ERM, epiretinal membrane
  • IOL, intraocular lens
  • IOP, intraocular pressure
  • logMAR, log minimum angle of resolution
  • Nd:YAG, neodymium-doped yttrium aluminium garnet
  • PCO, posterior capsular opacification
  • PMMA, polymethylmethacrylate

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Footnotes

  • Published Online First 17 January 2007

  • Funding: Scholarship fund to MAE from Tanta University, Tanta, Egypt.

  • Competing interests: None declared.

  • This paper was presented at the European Association of Vision and Eye Research (EVER) annual meeting, Vilamoura, Portugal, September, 2004.

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