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Outcome of phacoemulsification in patients with uveitis
  1. Mostafa A Elgohary (m.elgohary{at}doctors.org.uk),
  2. Peter McCluskey (iritis{at}ozemail.com.au),
  3. Hamish MA Towler (hmat{at}hmatowler.co.uk),
  4. Narciss Okhravi (narciss.okhravi{at}moorfields.nhs.uk),
  5. Ravinder Singh,
  6. Raal Obikpo (robikpo{at}hotmail.com),
  7. Susan Lightman (s.lightman{at}ucl.ac.uk)
  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
  4. Moorfields Eye Hospital, United Kingdom
  5. Whipps Cross University Hospital, United Kingdom
  6. Whipps Cross University Hospital, United Kingdom
  7. Moorfields Eye Hospital, United Kingdom

    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.

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