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Clinical science
Cataract surgery in uveitis: a multicentre database study
  1. Colin J Chu1,2,
  2. Andrew D Dick1,2,3,4,
  3. Robert L Johnston5†,
  4. Yit C Yang6,
  5. Alastair K Denniston7,8
  6. for the UK Pseudophakic Macular Edema Study Group
  1. 1Academic Unit of Ophthalmology, School of Clinical Sciences and School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
  2. 2Bristol Eye Hospital, Bristol, UK
  3. 3Institute of Ophthalmology, UCL, London, UK
  4. 4National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
  5. 5Gloucestershire Eye Unit, Cheltenham General Hospital, Cheltenham, UK
  6. 6Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  7. 7Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  8. 8Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
  1. Correspondence to Alastair K Denniston, Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham B18 7QH, UK; a.denniston{at}bham.ac.uk

Abstract

Background/aims Cataract is an important source of visual loss in patients with uveitis. Whether or not outcomes of cataract surgery in eyes with uveitis are worse compared with non-uveitic eyes have to date been compromised by lack of reliable estimates of benefit and harm, which require data from large cohorts.

Methods Electronic medical record data were extracted from eight independent UK clinical sites for eyes undergoing cataract extraction between January 2010 and December 2014. 1173 eyes with a recorded diagnosis of uveitis were compared with a reference group of 95 573 eyes from the same dataset.

Results Uveitic eyes represented 1.2% of all eyes undergoing cataract surgery. Eyes in the uveitic group had worse preoperative visual acuity (0.87 vs 0.65 logarithm of the minimum angle of resolution (logMAR) units), were from younger patients and had shorter axial lengths and a higher incidence of ocular copathology including glaucoma. A greater number had documented small pupils, required additional surgical procedures, developed more intraoperative complications and had poorer postoperative visual acuity at all time points measured up to 6 months (0.41 vs 0.27 logMAR units at 12–24 weeks).

Conclusions This large study cohort of eyes with a diagnosis of uveitis undergoing cataract surgery highlights more precisely the complex surgical demands, copathology and worse visual outcomes in this group. These data will allow more accurate preoperative counselling and planning. Although improvement in visual acuity is achieved in most cases, prognosis should be guarded, so that patient expectations are met. Compared with the non-uveitic population, the mean postoperative visual acuity is between one and two lines worse at all time points.

  • Inflammation
  • Treatment Surgery
  • Lens and zonules

https://doi.org/10.1136/bjophthalmol-2016-309047

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    Footnotes

    • †RLJ sadly passed away before final publication. The co-authors would like to dedicate this paper to him.

    • Acknowledgements The authors thank Dr Ines Leal, University of Lisbon, for her assistance with statistical analysis.

    • Collaborators Sobha Sivaprasad, Clare Bailey, Arijit Mitra, Atul Varma, Martin Mckibbin, Muhammed Tahir, Nick Lee and Peter Scanlon.

    • Contributors All authors (CJC, ADD, RLJ, YCY, AKD), according to ICMJE recommendations, made substantial contributions to the conception or design of the work, the acquisition, analysis, or interpretation of data for the work and drafting the work, revising it critically for important intellectual content and gave final approval of the version to be published. All agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding CJC is an NIHR Academic Clinical Lecturer in Ophthalmology. AKD has received a proportion of his funding from the following charities: Fight for Sight, the Birdshot Uveitis Society and the Uveitis Information Group (24BU151, 1994, 24UV13).

    • Competing interests There are no direct competing interests relating to this manuscript. Alcon (Fort Worth, TX, USA) provided a research grant to cover the cost of the initial data extraction, but has not played any role in the study design or conduct. All authors have completed ICMJE disclosure forms. RLJ is a shareholder and the Medical Director of Medisoft Limited.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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