Cataract surgery in exudative uveitis: effectiveness of total lens removal, anterior vitrectomy, and scleral fixation of PC IOLs

Cataract surgery in exudative uveitis is often followed by severe complications (pupillary seclusion/occlusion, dense posterior capsule/anterior vitreous opacification, cystoid macular edema following repeat YAG laser procedures) which often drastically limit functional recovery. Total removal of ca...

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Bibliographic Details
Published in:European journal of ophthalmology 2008-03, Vol.18 (2), p.220-225
Main Author: Secchi, A G
Format: Article
Language:English
Subjects:
Adult
Behcet Syndrome - complications
Cataract Extraction - methods
Exudates and Transudates
Humans
Lens Implantation, Intraocular - methods
Middle Aged
Postoperative Complications - prevention & control
Prospective Studies
Sarcoidosis - complications
Sclera - surgery
Treatment Outcome
Uveitis - complications
Uveomeningoencephalitic Syndrome - complications
Vitrectomy
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Summary:Cataract surgery in exudative uveitis is often followed by severe complications (pupillary seclusion/occlusion, dense posterior capsule/anterior vitreous opacification, cystoid macular edema following repeat YAG laser procedures) which often drastically limit functional recovery. Total removal of cataract, anterior vitrectomy, and scleral fixation of a posterior chamber (PC) intraocular lens (IOL) has been tried as a surgical alternative, searching for lessened postsurgical complications and a better outcome. Group A was a cohort of 12 patients with cataract after exudative (mostly sarcoidosis and Vogt-Koyanagi-Harada) uveitis, subjected to intracapsular cataract extraction, anterior vitrectomy, and scleral fixation of PC IOLs. Group B was the control group, including 12 patients with a similar clinical condition subjected to phacoemulsification or extracapsular cataract extraction plus in the- bag or in-the-sulcus IOL implantation. Follow-up time for both groups was at least 7 years. Postoperative inflammatory signs were substantially less in Group A patients, from 2 days up to >7 years postsurgery. Group A patients showed no cells/exudates adhering to the IOL surfaces, no synechiae, minimal (as compared to Group B) vitreous opacifications, and significantly higher visual acuity (p=0.024 at the seventh year control). Group A patients reported less frequent relapses of uveitis postsurgery, but the relevant clinical data did not allow statistical evaluations. Total removal of cataract in highly exudative uveitic eyes, plus anterior vitrectomy and scleral fixation of PC IOLs, although technically a more demanding surgical procedure, proved to be safe and more effective than classical procedures.
ISSN:1120-6721
1724-6016
DOI:10.1177/112067210801800209