Phacoemulsification and MSICS in uveitis eyes improved vision significantly (P < .001). The prior is recommended, given the higher rate of post-op complications in the later.
Abstract
Purpose:
To examine the visual outcomes and risk factors of uveitis cataract eyes after phacoemulsification and manual small-incision cataract surgery (MSICS).
Setting:
Tertiary-care eye hospital in southern India.
Design:
Retrospective interventional case series.
Methods:
Of the uveitis eyes operated for cataract surgery between 2017 and 2020, eyes with a minimum of 6 months postoperative follow-up were included. Eyes with ocular trauma, lens subluxation, lens-induced uveitis, or retinal detachment–induced uveitis were excluded. Demography, visual acuity, intraoperative and postoperative records, and surgical outcomes were analyzed.
Results:
191 eyes of 191 patients with a mean age of 51.7 ± 14.4 years were included. Phacoemulsification was performed in 134 eyes, and 57 eyes underwent MSICS. Synechiolysis and pupil-expanding maneuvers were required in 74 eyes (38.7%). No differences were noted in the rates of complications between phacoemulsification and MSICS eyes, except at 1 year, where higher rates of posterior capsular opacification and vitritis were noted in MSICS eyes (P = .018). The visual outcomes of eyes that underwent MSICS and phacoemulsification were comparable (P = .463). In 12 eyes (13.5%), improvement in vision was not significant.
Conclusions:
This study shows phacoemulsification may be a preferred technique in uveitis cataracts, given the lesser incidence of postoperative complications. Patients should be counseled for realistic expectations.
Cataract is a common complication in patients with uveitis and is the main cause of reversible blindness in these patients.1 Cataract formation in uveitis results from chronic intraocular inflammation and long-term corticosteroid use in treating the inflammation.2
The management of cataracts in these patients with ocular inflammation has historically been a challenge, being technically more difficult and providing less reliable outcomes than the management of age-related cataracts.3–5 Poor pupillary dilation and intraoperative complications due to posterior synechia, poor stability of the capsule or zonular fibers, pupillary membranes, and bleeding from fragile vessels pose surgical challenges for the cataract surgeon that require additional procedures and result in more complications (Supplementary Figure 1, available at http://links.lww.com/JRS/B31).6–8
Apart from the recommendation to perform cataract surgery during a quiescent interval with little or no inflammation, supplementary anti-inflammatory treatment before cataract surgery has been advocated in several studies.9–11 The improved visual prognosis after cataract surgery in eyes with uveitis in recent years seems to be related to the more consistent use of perioperative anti-inflammatory and immunosuppressive treatment regimens.12
The results of cataract surgery are difficult to assess as eyes with different uveitis syndromes respond differently to surgery. With an improved understanding of disease processes, optimization of immunosuppression for perioperative control of inflammation, minimally invasive surgical techniques, availability of biocompatible intraocular lens (IOL) material, and design and surgeons trained in performing complicated cataract surgeries and anticipatory management of postoperative complications, the outcome has been maximized.13
Phacoemulsification with simultaneous IOL implantation is the standard method of cataract surgery for most patients with uveitis. However, manual small-incision cataract surgery (MSICS) has emerged as a cost-effective alternative in developing countries, where the blindness rate in terms of disability-adjusted life years is more than 99%.14 In age-related cataracts, MSICS and phacoemulsification provided similar corrected distance visual acuity (CDVA) outcomes in the short term (up to 3 months of surgery).15 Our study reports the comparative safety and efficacy profiles of phacoemulsification and MSICS in eyes with uveitis cataracts and the risk of intraoperative and postoperative complications and interventions during 1-year follow-up.
METHODS
This was a retrospective study conducted in Aravind Eye Hospital, Madurai, Tamil Nadu, India. Informed consent was obtained from all patients and parents of all children preoperatively, and the study followed all tenets of the Declaration of Helsinki. After obtaining ethics committee approval (RET201900215), data were retrieved from the electronic medical record of patients with uveitis cataracts operated between January 2017 and December 2020. The types of cataract surgeries included MSICS and phacoemulsification with posterior chamber IOL implantation. Preoperatively, patients underwent detailed systemic and ocular examinations, including the recording of CDVA, slitlamp examination, fundus examination, along with the recording of intraocular pressure. Where the medium was hazy or had total cataracts obscuring the view of the fundus, ocular ultrasonography was performed. Routine laboratory investigations were performed in all cases, and specific investigations were performed if indicated. The final diagnosis was based on history, clinical findings, and the results of laboratory investigations.
The classification of uveitis was based on the definitions proposed by the Standardization of Uveitis Nomenclature working group.16 Wherever indicated, systemic steroids were given preoperatively, continued postoperatively, and doses tapered according to the inflammatory response. All uveitis cataracts that were operated on in the abovementioned time line were included in this study. Patients were eligible if uveitis had been in a quiescent state for ≥3 months. Patients were excluded from this study if they had a history of ocular trauma, lens subluxation, lens-induced uveitis, or retinal detachment–induced uveitis.
Data fields extracted on demographics and preoperative characteristics included age, sex, laterality, uveitis type, cataract type, preexisting copathologies, preoperative follow-up, use of preoperative steroids, visual acuity (VA), and intraocular pressure. Data fields extracted from intraoperative records included pupil size, type of surgery, additional procedures, and intraoperative complications. Data fields extracted from postoperative visits included CDVA, intraocular pressure, findings from the cornea, anterior chamber, pupil size/shape, IOL status, anterior/posterior capsule, fundus, cause of decreased vision, and any intervention undergone postoperatively. Preoperative VA and intraocular pressure used the values recorded closest to the date of surgery. Postoperatively, patients were followed up on day 1, 1 month, 3 months, 6 months, and 12 months. VA was recorded using the Snellen chart.
Cataract extraction (phacoemulsification/MSICS) was performed under sub-Tenon anesthesia for all these cases, as intraoperative interventions were anticipated. MSICS was performed in eyes where advanced cataract was present or in patients who could not afford phacoemulsification surgery with additional pupil-expanding devices, capsular tension rings, or high-density ophthalmic viscosurgical materials. Both phacoemulsification and MSICS were performed by an experienced senior surgeon. All IOLs were hydrophobic acrylic. In eyes with synechiae, synechiolysis was performed, and for the small, nondilating pupils, expansion was performed either by stretch pupilloplasty or using iris hooks before capsulorhexis.
Routine postoperative ophthalmic management included topical ofloxacin 0.3% eyedrop 3 times daily for 2 weeks and topical prednisolone 1% eyedrop for 6 weeks in a tapering dose started from 6 times daily per week. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) were started 1 month postoperatively for 4 weeks, except in patients with diabetic retinopathy in whom they were started the next day after the surgery. Cycloplegics were added in appropriate cases.
Statistical Analysis
Descriptive statistics were presented with frequency and percentage for categorical parameters. Mean and SDs were used for continuous parametric data while median and interquartile ranges (IQRs) were used for nonparametric data. Parametric statistical tests were used if the data were distributed normally, and for skewed data, nonparametric tests were performed. The normality of the data was checked using the Shapiro-Wilk test. Friedman test was used to find out the significant difference over the time. Wilcoxon signed-rank test was performed as a post hoc test for pairwise comparisons. P value less than 0.05 was considered statistically significant. All statistical analyses were conducted using the statistical software STATA 17.0 (Statacorp LLC).
RESULTS
Patient Characteristics at Baseline
A total of 248 eyes of 239 patients underwent cataract surgery during the study period, of which 191 eyes (77%) of 191 patients were eligible for inclusion and statistical analysis. The age of the participants (mean ± SD age) was 51.7 ± 14.4 years, and 96 participants (50.3%) were male. Preoperatively, 75 patients (39.3%) received systemic steroids and 17 eyes (8.9%) were on ocular hypotensive therapy. More than one third of eyes (38.7%) had posterior synechiae at the time of surgery. Phacoemulsification was performed in 134 eyes (70.2%), and the rest underwent MSICS. There were no differences in the demographic and baseline characteristics of the eyes in the 2 surgical technique groups, except baseline VA (Table 1).
Table 1.
Baseline characteristics
| Factors | Procedures | P value | |
| Phacoemulsification (n = 134) | MSICS (n = 57) | ||
| Age (y), mean ± SD (range) | 50.6 ± 13.9 (17, 81) | 54.5 ± 15.3 (12, 81) | .055 |
| Sex, n (%) | .248 | ||
| M | 71 (53) | 25 (43.9) | |
| F | 63 (47) | 32 (56.1) | |
| Eye, n (%) | .496 | ||
| Right | 54 (40.3) | 26 (45.6) | |
| Left | 80 (59.7) | 31 (54.4) | |
| Preop on oral steroids, n (%) | .093 | ||
| No | 82 (61.2) | 34 (59.7) | |
| Yes | 52 (38.8) | 23 (40.3) | |
| On antiglaucoma therapy, n (%) | 8 (6.0) | 5 (8.8) | .482 |
| CDVA (logMAR) | <.001* | ||
| Median (Snellen VA) | 1 (20/200) | 1.78 (20/200) | |
| IQR | 0.48, 1.78 | 0.78, 2.60 | |
| Anatomical type, n (%) | |||
| Anterior uveitis | 100 (74.6) | 52 (91.2) | .009* |
| Intermediate uveitis | 17 (12.7) | 3 (5.3) | .125 |
| Posterior uveitis | 6 (4.5) | 1 (1.7) | .092 |
| Panuveitis | 11 (8.2) | 1 (1.7) | .358 |
IQR = interquartile range; MSICS = manual small-incision cataract surgery
Statistically significant
Anatomical Classification and Etiology of Uveitis
Most of the eyes (77.0%) were suffering from anterior uveitis of idiopathic (34.7%) and viral (23.8%) etiologies. Similarly, intermediate uveitis eyes had 45% idiopathic etiology, and the greater number of posterior and panuveitis cases were due to toxoplasmosis (57.1%) and sympathetic ophthalmia (29.4%), respectively (Table 2).
Table 2.
Etiology and anatomical classification of uveitis
| Parameter | Anterior (n = 152) | Intermediate (n = 20) | Posterior (n = 7) | Pan (n = 12) | Overall (n = 191) | |||||
| PE (n = 100) | MSICS (n = 52) | PE (n = 17) | MSICS (n = 3) | PE (n = 6) | MSICS (n = 1) | PE (n = 11) | MSICS (n = 1) | PE (n = 134) | MSICS (n = 57) | |
| Idiopathic | 30 (30) | 21 (40.4) | 9 (52.9) | — | 1 (16.7) | — | 2 (18.2) | 1 (100) | 42 (31.3) | 22 (38.6) |
| Viral | 24 (24) | 11 (21.2) | — | — | — | 1 (100) | — | — | 24 (17.9) | 12 (21.1) |
| Leptospirosis | 13 (13) | 4 (7.7) | 2 (11.8) | — | — | — | — | — | 15 (11.2) | 4 (7) |
| Ocular tuberculosis | 5 (5) | 2 (3.8) | 4 (23.5) | 1 (33.3) | 1 (16.7) | — | 3 (27.3) | — | 13 (9.7) | 3 (5.3) |
| Fuchs heterochromia | 15 (15) | 4 (7.7) | — | — | — | — | 1 (9.1) | — | 16 (11.9) | 4 (7) |
| Sarcoidosis | 4 (4) | — | 2 (11.8) | 2 (66.7) | — | — | 1 (9.1) | 7 (5.2) | 2 (3.5) | |
| Toxoplasmosis | 1 (1) | — | — | — | 4 (66.7) | — | 2 (18.2) | — | 7 (5.2) | — |
| Sympathetic ophthalmia | 2 (2) | 3 (5.8) | — | — | — | — | — | — | 2 (1.5) | 3 (5.3) |
| H27-related uveitis | 5 (5) | 3 (5.8) | — | — | — | — | — | — | 5 (3.7) | 3 (5.3) |
| Others | 1 (1) | 4 (7.7) | — | — | — | — | 2 (18.2) | 3 (2.2) | 4 (7) | |
MSICS = manual small-incision cataract surgery; PE = phacoemulsification
Additional Procedures
Nearly every second patient (41.4%) required additional intervention intraoperatively, higher in the MSICS group (63.2%) compared with the phacoemulsification group (32.1%) (P < .001). Most of these eyes required synechiolysis and pupil-expanding maneuvers (n = 74, 38.7%), and a few required capsular support devices (1%) and peripheral iridectomy (0.3%) (Supplementary Table 1, available at http://links.lww.com/JRS/B32).
Complications and Interventions
Intraoperative complications occurred in 7 eyes (3.6%), with posterior capsular rupture (PCR) in 4 eyes (2.1%), aphakia in 1 eye (0.5%), and zonular dialysis in 2 eyes (1.0%). Postoperative complications were observed in 113 eyes (59.1%) during the follow-up period (Table 3). Recurrence of uveitis was the most commonly encountered problem during the follow-up period, occurring in 61 eyes (40%). Interventions were done in 2% of eyes during the first postoperative day and in 12.6% of eyes at 6 months of follow-up. Posterior capsular opacity (PCO) formed in 24 eyes (12.6%) between 6 months and 12 months of follow-up. Nd:YAG capsulotomy was performed in 8 eyes (4.2%). Macular edema developed in 16 eyes (8.37%) after cataract surgery and was treated with topical NSAIDs and posterior sub-Tenon injection of triamcinolone (13 eyes). A rise in IOP requiring treatment occurred in 5 eyes (2.6%).
Table 3.
Postoperative complications after cataract surgery during follow-up according to etiology of uveitis
| Anatomical type | Etiology | Postoperative complications, na (%) | |||||
| Recurrent uveitis | CME | Vitritis | PCO | Keratitis | High IOP | ||
| Anterior uveitis | Idiopathic | 15 (33.3) | 4 (30.8) | 7 (38.9) | 11 (57.9) | — | 1 (33.3) |
| Viral uveitis | 11 (24.4) | 2 (15.4) | 2 (11.1) | 4 (21.1) | 3 (100.0) | — | |
| Fuchs heterochromia | 4 (8.9) | — | 1 (5.6) | 1 (5.3) | — | 1 (33.3) | |
| Leptospirosis | 2 (4.4) | — | 2 (11.1) | 1 (5.3) | — | — | |
| Ocular tuberculosis | 4 (8.9) | 4 (30.8) | 2 (11.1) | — | — | — | |
| Sarcoidosis | 3 (6.7) | 2 (15.4) | 2 (11.1) | 1 (5.3) | — | — | |
| H27-related uveitis | 2 (4.4) | — | 1 (5.6) | — | — | 1 (33.3) | |
| Sympathetic ophthalmitis | 1 (2.2) | — | — | — | — | — | |
| Behcet disease | 1 (2.2) | — | 1 (5.6) | — | — | — | |
| JRA | 1 (2.2) | — | — | 1 (5.3) | — | — | |
| Psoriasis | 1 (2.2) | 1 (7.7) | — | — | — | — | |
| Total | 45 | 13 | 18 | 19 | 3 | 3 | |
| Intermediate uveitis | Idiopathic | 4 (50.0) | — | 3 (50.0) | — | — | 1 (100.0) |
| Ocular tuberculosis | 2 (25.0) | 1 (100.0) | 2 (33.3) | — | — | — | |
| Sarcoidosis | 2 (25.0) | — | 1 (16.7) | — | — | — | |
| Leptospirosis | — | — | — | — | — | — | |
| Total | 8 | 1 | 6 | — | — | 1 | |
| Posterior uveitis | Ocular tuberculosis | 1 (50.0) | — | 1 (100.0) | 1 (50.0) | — | — |
| Toxoplasmosis | 1 (50.0) | — | — | — | — | — | |
| Viral | — | — | — | 1 (50.0) | — | — | |
| Total | 2 | — | 1 | 2 | — | — | |
| Pan uveitis | Idiopathic | 2 (33.3) | 2 (100.0) | 1 (100.0) | — | — | 1 (100.0) |
| Ocular tuberculosis | 2 (33.3) | — | — | 1 (33.3) | — | — | |
| Toxoplasmosis | 1 (16.7) | — | — | 1 (33.3) | — | — | |
| Behcet disease | — | — | — | 1 (33.3) | — | — | |
| Sarcoidosis | 1 (16.7) | — | — | — | — | — | |
| Total | 6 | 2 | 1 | 3 | — | 1 | |
CME = cystoid macular edema; JRA = juvenile rheumatoid arthritis; PCO = posterior capsular opacification
Multiple complications were noted in several eyes
There were no differences in the rates of surgical complications in the eyes that underwent phacoemulsification and MSICS, except at 1 year, when higher rates of PCO and vitritis were noted in MSICS eyes (P = .018) (Table 4).
Table 4.
Comparison of the complications of phacoemulsification vs MSICS eyes
| Complications | Surgery procedure, n (%) | Overall (n = 191) | P value | |
| Phacoemulsification (n = 134) | MSICS (n = 57) | |||
| Day 1 | .534 | |||
| Nil | 95 (71.4) | 36 (63.2) | 131 (68.9) | |
| Epithelial edema | 17 (12.8) | 9 (15.8) | 26 (13.7) | |
| Iritis | 15 (11.3) | 7 (12.3) | 22 (11.6) | |
| Keratitis | 5 (3.8) | 5 (8.8) | 10 (5.3) | |
| Vitritis | 1 (0.8) | — | 1 (0.5) | |
| First month | .589 | |||
| Nil | 103 (79.2) | 43 (76.8) | 146 (78.5) | |
| Iritis | 12 (9.2) | 4 (7.1) | 16 (8.6) | |
| Vitritis | 10 (7.7) | 4 (7.1) | 14 (7.5) | |
| CME | 3 (2.3) | 3 (5.4) | 6 (3.2) | |
| Steroid-induced HTN | 1 (0.8) | 1 (1.8) | 2 (1.1) | |
| Epithelial edema | — | 1 (1.8) | 1 (0.5) | |
| Raised IOP | 1 (0.8) | — | 1 (0.5) | |
| Third month | .145 | |||
| Nil | 48 (67.6) | 13 (46.4) | 61 (61.6) | |
| Iritis | 9 (12.7) | 7 (25.0) | 16 (16.2) | |
| CME | 5 (7.0) | 4 (14.3) | 9 (9.1) | |
| Vitritis | 5 (7.0) | 2 (7.1) | 7 (7.1) | |
| PCO | 3 (4.2) | — | 3 (3.0) | |
| Keratitis | 1 (1.4) | 1 (3.6) | 2 (2.0) | |
| Steroid-induced HTN | — | 1 (3.6) | 1 (1.0) | |
| Sixth month | .956 | |||
| Nil | 30 (50.0) | 12 (46.2) | 42 (48.8) | |
| Vitritis | 10 (16.7) | 5 (19.2) | 15 (17.4) | |
| Iritis | 9 (15.0) | 4 (15.4) | 13 (15.1) | |
| PCO | 5 (8.3) | 3 (11.5) | 8 (9.3) | |
| CME | 2 (3.3) | 2 (7.7) | 4 (4.7) | |
| Keratitis | 2 (3.3) | — | 2 (2.3) | |
| ERD | 1 (1.7) | — | 1 (1.2) | |
| Steroid-induced HTN | 1 (1.7) | — | 1 (1.2) | |
| First year | .018* | |||
| Nil | 38 (56.7) | 6 (27.3) | 44 (49.4) | |
| PCO | 11 (16.4) | 6 (27.3) | 17 (19.1) | |
| Vitritis | 4 (6.0) | 7 (31.8) | 11 (12.4) | |
| Iritis | 8 (11.9) | 1 (4.6) | 9 (10.1) | |
| CME | 3 (4.5) | 1 (4.6) | 4 (4.5) | |
| Glaucoma | 1 (1.5) | 1 (4.6) | 2 (2.3) | |
| Keratitis | 1 (1.5) | — | 1 (1.1) | |
| ERD | 1 (1.5) | — | 1 (1.1) | |
CME = cystoid macular edema; ERD = exudative retinal detachment; HTN = hypertension; MSICS = manual small-incision cataract surgery; PCO = posterior capsular opacity
Statistically significant
Visual Outcome
The median preoperative logMAR CDVA was 1.08 (IQR, 0.48 to 1.78), which improved to 0.18 (IQR, 0 to 0.48; P < .001) immediately after cataract surgery and remained significantly improved compared with baseline at 3, 6, and 12 months (P < .001 at all points).
The visual outcomes as per etiology are shown in Figure 1 and are also listed in Supplementary Table 2 (available at http://links.lww.com/JRS/B32). The best visual outcome was noted in anterior uveitis eyes (median, 0.18; IQR, 0 to 0.60) at the last visit, followed by posterior uveitis eyes (median, 0.3; IQR, 0 to 0.48) and intermediate uveitis eyes (median, 0.48; IQR, 0 to 1.08). Panuveitis eyes showed the least visual recovery (median, 0.6; IQR, 0.18 to 1.78). There was no significant difference in the overall visual outcome of eyes that underwent MSICS with those that underwent phacoemulsification (P = .463). However, differences were noted when various anatomical types of uveitis were compared (Supplementary Table 3, available at http://links.lww.com/JRS/B32). Vision did not significantly improve in 12 eyes (13.5%), at 1 year after the intervention. The distribution of visual recovery during follow-up is shown in Figure 2.
Figure 1.
Visual outcomes of the eyes according to etiology of uveitis.
Figure 2.
Postoperative visual outcomes of uveitis eyes during 1-year follow-up.
DISCUSSION
VA of the uveitis eyes improved significantly after cataract surgery (P < .001). In 86.5% of eyes, vision improved from baseline at 1-year follow-up. This is in agreement with several other studies that reported short and long-term visual improvement in up to 93% patients.1,3,17
After 1 year of follow-up, 90.7% of anterior uveitis eyes reached vision of 20/30 (logMAR median, 0.18; IQR, 0 to 0.60), whereas 83% of intermediate uveitis eyes, 71% of panuveitis eyes, and 60% of posterior uveitis eyes reached vision of 20/60 (logMAR median, 0.48; IQR, 0 to 1.08), 20/80 (logMAR median, 0.60; IQR, 0.18 to 1.78), and 20/40 (logMAR median, 0.30; IQR, 0 to 0.48), respectively. Kosker et al. reported that the CDVA was 20/40 or better in 94.5% of eyes with anterior uveitis at 6-month follow-up.7 Ganesh et al. reported that 91% of eyes with intermediate uveitis showed a favorable visual outcome at a mean follow-up of 19.67 months.18 Okhravi et al. reported that in the posterior disease group, 81% of patients showed an improvement in vision (median, +4 Snellen lines) at 6 months of follow-up.1 Final CDVA in the anterior disease group was better than the posterior group. Approximately 47.3% of eyes in the posterior disease group (posterior and panuveitis) had preoperative chorioretinal scars. In the posterior disease group, a poor visual outcome was noted to be most commonly the result of vision-limiting conditions present preoperatively.1,19
The major intraoperative challenge was small pupils in 56% of MSICS cases and 31.3% of phacoemulsification cases. Thus, additional intervention intraoperatively was higher in the MSICS group (63.2%) compared with the phacoemulsification group (32.1%) (P < .001). Both phacoemulsification and MSICS delivered good outcomes. At the last visit, 81.8% of eyes in the MSICS group and 88% of eyes in the phacoemulsification group showed improvement of 20/80 (logMAR median, 0.60; IQR, 0.18 to 0.78) and 20/30 (logMAR median, 0.18; IQR, 0 to 0.60), respectively. This was comparable with studies by Bhargava et al. and Ruit et al.8,20
Despite significant visual improvement, 59.1% of eyes presented with postoperative complications during the follow-up period. Postoperative uveitis relapse (40%) was the most frequent complication, followed by posterior capsular opacification (12.6%) and cystoid macular edema (8.37%). Suresh et al. reported recurrent uveitis in 36%, posterior capsular opacification in 42%, and cystoid macular edema in 2% of eyes after a mean follow-up of 24.1 months.3 Meda and group showed that recurrent uveitis, cystoid macular edema, and posterior capsular opacification occurred in 15.5%, 7%, and 5.5% eyes, respectively, over a mean follow-up of 9.8 months after MSICS.21
There was no significant difference in the complication rate with different locations of uveitis and also with different types of surgeries. This was comparable with the study by Bhargava et al.8 However, at the 1-year follow-up, the rate of PCO (27.3%) and recurrent uveitis (36.4%) in the MSICS group was slightly higher than the phacoemulsification group (PCO = 16.4% and recurrent rate = 25.3%) (P = .018). This could be because of the higher percentage of eyes with small pupils (56%) and denser grade of cataracts (38.6%) in the MSICS group, needing considerable intraocular manipulation. However, a particular factor resulting in a higher incidence of recurrent uveitis in the MSICS subgroup was not identified. In the late postoperative period, the rate of both PCO and recurrence increased. Regarding posterior capsular opacification or accumulations in IOL, there are 2 types of cellular responses. The first cellular response is the small round cell–type inflammatory cell accumulation on the IOL and is seen in the early period. The second type of cellular response, involving giant cells, predominates in the late period and is considered to indicate prolonged inflammation, being highly responsible for the pathogenesis of the uveal biocompatibility of the IOL material.22
The limitations of the study are that it is retrospective in nature, had outcomes from 2 types of surgeries conducted by multiple phacorefractive and uvea consultants of the institute, and multiple hydrophobic IOLs were used. A longer follow-up of these eyes would provide better knowledge of complications and interventions.
Our outcome recommends phacoemulsification as a preferred technique in the uveitis eye, given the lesser incidence of postoperative complications. A small percentage of uveitis eyes do not gain vision despite the best preoperative, intraoperative, and postoperative precautions. Patients have to be counseled for realistic expectations. Persistent uveitis is an important cause of decreased vision. This set of cataract eyes needs close, long-term monitoring and prompt treatment if any sign of inflammation occurs.
In conclusion, this study suggests preferring phacoemulsification over MSICS in patients with uveitis whenever possible. In addition, careful patient selection and counseling of postoperative outcomes, rigorous preoperative inflammation control, and close follow-up are essential in these eyes.
WHAT WAS KNOWN
Cataract surgery in uveitis eyes needs meticulous planning and close follow-up.
Delayed visual recovery and uveitis recurrence are common complications.
WHAT THIS PAPER ADDS
Despite advances in the MSICS technique, phacoemulsification is recommended in uveitis cataract eyes, whenever possible, given higher PCO and vitritis rates following the prior.
Reports that nearly one in every seven uveitis cataract surgeries, the visual outcome is not significant at 1-year follow-up.
Acknowledgments
The authors thank Ms. R. Kumaragurupari, PhD, Chief Librarian, Aravind Library and Information Centre, for all her academic inputs.
Footnotes
M. Shekhar and S. Chaudhary contributed equally to this work.
Disclosures: None of the authors have any financial or proprietary interest in any material or method mentioned.
First author:
Madhu Shekhar, MS
Cataract Services, Aravind Eye Hospital, Madurai, India
Contributor Information
Madhu Shekhar, Email: madhushekhar93@gmail.com.
Sushmita Chaudhary, Email: sushmitatinni@gmail.com.
Aruna Pai, Email: arunadpk3@gmail.com.
Vedhanayaki Rajesh, Email: vedharajesh8@gmail.com.
Logesh Balakrishnan, Email: logeshmani1997@gmail.com.
Kamatchi Nagu, Email: iolresearch@aravind.org.
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