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Lee DJ, Seto S, Banghart M, Boyd K, Thuruthumaly C, Suhler EB, Kopplin LJ. Risk Factors Associated with Unexpected Refractive Outcomes in Uveitic Cataract Surgery. Ocul Immunol Inflamm 2024; 32:642-647. [PMID: 36931285 PMCID: PMC10505240 DOI: 10.1080/09273948.2023.2187847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Assess refractive outcomes following uveitic cataract surgery and identify factors associated with deviations from the target refractive goal. METHODS A multicenter retrospective chart review was performed for 216 subjects with uveitis undergoing cataract surgery. Prediction error was calculated and tested for association with demographic and clinical characteristics using single variable and multiple regression analysis. RESULTS 39.8% of eyes deviated from the intended refractive target by at least 0.5 diopters (D). The mean prediction error was 0.56 ± 0.67 D. Younger age (p = 0.042), preoperative inflammatory corneal findings (keratic precipitates and/or band keratopathy) (p = 0.0004), and poorer postoperative visual acuity (p = 0.0054) were associated with a deviation from the intended refractive target by at least 1 D. CONCLUSIONS A higher percentage of eyes undergoing uveitic cataract surgery deviated from the intended refractive target when compared to reported refractive outcomes in normal subjects. Younger age, preoperative inflammatory corneal sequelae, and poorer postoperative visual acuity were associated with this outcome.
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Affiliation(s)
- Daniel J. Lee
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Steven Seto
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mark Banghart
- Department of Ophthalmology and Visual Sciences, University of Wisconsin - Madison, Madison, WI, USA
| | - Kelly Boyd
- Department of Ophthalmology and Visual Sciences, University of Wisconsin - Madison, Madison, WI, USA
| | - Catherine Thuruthumaly
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eric B. Suhler
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Ophthalmology, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Laura J. Kopplin
- Department of Ophthalmology and Visual Sciences, University of Wisconsin - Madison, Madison, WI, USA
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Gangaputra S, Newcomb C, Armour R, Choi D, Ying GS, Groth S, Begum H, Fitzgerald T, Artornsombudh P, Daniel E, Bhatt N, Foster S, Jabs D, Levy-Clarke G, Nussenblatt R, Rosenbaum JT, Sen HN, Suhler E, Thorne J, Dreger K, Buchanich J, Kempen JH. Long-term visual acuity outcomes following cataract surgery in eyes with ocular inflammatory disease. Br J Ophthalmol 2024; 108:380-385. [PMID: 36810151 DOI: 10.1136/bjo-2022-322236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To evaluate the long-term visual acuity (VA) outcome of cataract surgery in inflammatory eye disease. SETTING Tertiary care academic centres. DESIGN Multicentre retrospective cohort study. METHODS A total of 1741 patients with non-infectious inflammatory eye disease (2382 eyes) who underwent cataract surgery while under tertiary uveitis management were included. Standardised chart review was used to gather clinical data. Multivariable logistic regression models with adjustment for intereye correlations were performed to evaluate the prognostic factors for VA outcomes. Main outcome measure was VA after cataract surgery. RESULTS Uveitic eyes independent of anatomical location showed improved VA from baseline (mean 20/200) to within 3 months (mean 20/63) of cataract surgery and maintained through at least 5 years of follow-up (mean 20/63). Eyes that achieved 20/40 or better VA at 1 year were more likely to have scleritis (OR=1.34, p<0.0001) or anterior uveitis (OR=2.2, p<0.0001), VA 20/50 to 20/80 (OR 4.76 as compared with worse than 20/200, p<0.0001) preoperatively, inactive uveitis (OR=1.49, p=0.03), have undergone phacoemulsification (OR=1.45 as compared with extracapsular cataract extraction, p=0.04) or have had intraocular lens placement (OR=2.13, p=0.01). Adults had better VA immediately after surgery, with only 39% (57/146) paediatric eyes at 20/40 or better at 1 year. CONCLUSIONS Our results suggest that adult and paediatric eyes with uveitis typically have improved VA following cataract surgery and remain stable thereafter for at least 5 years.
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Affiliation(s)
| | - Craig Newcomb
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rebecca Armour
- Department of Ophthalmology, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Dongseok Choi
- Public Health and Preventive Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Gui-Shuang Ying
- Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sylvia Groth
- Vanderbilt Eye Institute, Nashville, Tennessee, USA
| | - Hosne Begum
- Wilmer Eye Institute, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
| | - Tonetta Fitzgerald
- Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pichaporn Artornsombudh
- Ophthalmology, Somdech Phra Pinklao Hospital, Bangkok, Thailand
- Chulalongkorn University, Bangkok, Thailand
| | - Ebenezer Daniel
- Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nirali Bhatt
- Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Sight for Souls, Fort Myers, Florida, USA
| | - Douglas Jabs
- Wilmer Eye Institute, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Grace Levy-Clarke
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA
- The Tampa Bay Uveitis Center, St Petersburg, Florida, USA
| | - Robert Nussenblatt
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Legacy Devers Eye Institute at Good Samaritan Medical Center, Portland, Oregon, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA
| | - Eric Suhler
- Department of Ophthalmology, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
- Ophthalmology, Veterans Health Administration, Portland, Oregon, USA
| | - Jennifer Thorne
- Wilmer Eye Institute, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kurt Dreger
- Wilmer Eye Institute, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
- Ophthalmology, Somdech Phra Pinklao Hospital, Bangkok, Thailand
- Center for Occupational Biostatistics and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeanine Buchanich
- Center for Occupational Biostatistics and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - John H Kempen
- Sight for Souls, Fort Myers, Florida, USA
- Departments of Ophthalmology and Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Ophthalmology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
- MCM Eye Unit, MyungSung Christian Medical Center General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
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Jabs DA, Sugar EA, Burke AE, Altaweel MM, Dunn JP, Gangaputra S, Kempen JH, Pepple KL, Stawell RJ, Holbrook JT. Cataract Surgery in Patients With Uveitis Treated With Systemic Therapy in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study: Risk Factors and Outcomes. Am J Ophthalmol 2023; 254:210-220. [PMID: 37406846 PMCID: PMC10528707 DOI: 10.1016/j.ajo.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE To evaluate the rate of, risk factors for, and outcomes of cataract surgery in patients with intermediate, posterior, and panuveitides treated with systemic corticosteroids and immunosuppression. DESIGN Cohort study of participants from a randomized clinical trial. METHODS A multicenter clinical trial with extended follow-up comprised the study setting. From the cohort of participants assigned to systemic therapy in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study, 125 phakic eyes of 74 patients with intermediate, posterior, or panuveitides treated with systemic therapy were included. The main outcome measures were cataract surgery and visual acuity after cataract surgery. RESULTS The cumulative incidence of cataract surgery was 43% at 7 years of follow-up, and the risk did not plateau. Risk factors for cataract surgery included age >50 years (hazard ratio [HR] 2.86, 95% CI 1.52, 5.42; P = .001), topical corticosteroid use (time-updated HR 3.13, 95% CI 1.42, 6.94; P = .005), glaucoma medication use (HR 2.75, 95% CI 1.38, 5.47; P = .004), and possibly history of anterior chamber inflammation (HR 1.90, 95% CI 0.95, 3.84; P = .07). Median gain in acuity and median best corrected visual acuity 1 year after cataract surgery were 4.8 lines and 20/25, respectively, among 42 eyes undergoing cataract surgery with 1-year follow-up data. CONCLUSIONS Among patients with intermediate, posterior, and panuveitides, treated with oral corticosteroids and immunosuppression, there is a substantial long-term risk of cataract surgery. Visual acuity outcomes after cataract surgery are generally good.
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Affiliation(s)
- Douglas A Jabs
- From the Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (D.A.J., E.A.S., A.E.B., J.T.H.), Baltimore, Maryland, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine (D.A.J.), Baltimore, Maryland, USA.
| | - Elizabeth A Sugar
- From the Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (D.A.J., E.A.S., A.E.B., J.T.H.), Baltimore, Maryland, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health (E.A.S.), Baltimore, Maryland, USA
| | - Alyce E Burke
- From the Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (D.A.J., E.A.S., A.E.B., J.T.H.), Baltimore, Maryland, USA
| | - Michael M Altaweel
- School of Medicine and Public Health, Department of Ophthalmology and Reading Center, University of Wisconsin, Madison (M.M.A.), Madison, Wisconsin, USA
| | - James P Dunn
- Wills Eye Hospital, Department of Ophthalmology, Thomas Jefferson University (J.P.D.), Philadelphia, Pennsylvania, USA
| | - Sapna Gangaputra
- Vanderbilt Eye Institute, Vanderbilt University School of Medicine (S.G.), Nashville, Tennessee, USA
| | - John H Kempen
- Department of Ophthalmology Harvard Medical School and Massachusetts Eye and Ear Infirmary (J.H.K.), Boston, Massachusetts, USA; MCM Eye Unit, Myung Sung Christian Medical Center General Hospital and Medical School (J.H.K.), Addis Ababa, Ethiopia
| | - Kathryn L Pepple
- Department of Ophthalmology, University of Washington School of Medicine (K.L.P.), Seattle, Washington, USA
| | - Richard J Stawell
- Department of Ophthalmology, University of Melbourne, Royal Victorian Eye and Ear Hospital (R.J.S.), East Melbourne, Victoria, Australia
| | - Janet T Holbrook
- From the Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (D.A.J., E.A.S., A.E.B., J.T.H.), Baltimore, Maryland, USA
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Pålsson S, Pivodic A, Grönlund MA, Lundström M, Viberg A, Behndig A, Zetterberg M. Cataract surgery in patients with uveitis: Data from the Swedish National Cataract Register. Acta Ophthalmol 2023; 101:376-383. [PMID: 36537142 DOI: 10.1111/aos.15308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/11/2022] [Accepted: 12/02/2022] [Indexed: 05/10/2023]
Abstract
PURPOSE To investigate the surgical and pharmacological management and outcomes of patients with cataract and concurrent uveitis. METHODS Data from the Swedish National Cataract Register, 2018-2019, were collected and analysed. Uveitic eyes were identified and eyes without uveitis were used as controls. Generalized estimating equations were used to adjust for intra-individual correlation. RESULTS The study included 719 eyes with and 256 360 without uveitis. The mean age was 66.0 ± 13.5 (standard deviation [SD]) years in the uveitis group and 74.3 ± 8.7 years in the control group (p < 0.001). Surgery was associated with more intraoperative difficulties in eyes with uveitis (27.0%) than in control eyes (7.1%; p < 0.001). Posterior capsule rupture/zonular complications were registered in nine eyes with uveitis (1.3%) and in 1464 eyes without uveitis (0.6%; p = 0.02). Hydrophilic acrylic intraocular lenses (uveitis 3.6%, controls 1.2%) and subconjunctival steroids (uveitis 17.4%, controls 6.1%) were more frequently used in eyes with uveitis (p < 0.001). post-operative best-corrected visual acuity (BCVA) was 0.16 ± 0.38 logarithm of the minimum angle of resolution (logMAR, mean ± SD) in eyes with uveitis (n = 52) and 0.08 ± 0.20 in control eyes (n = 14 489; p = 0.008). CONCLUSION In this large registry-based Swedish cohort study, the findings demonstrate that cataract surgery in patients with uveitis poses more challenges and requires special surgical precautions. Eyes with concurrent uveitis had worse BCVA prior to and following surgery. Despite the intraoperative challenges, the visual improvement was greater in the uveitic group.
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Affiliation(s)
- Sara Pålsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden
| | - Aldina Pivodic
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Ophthalmology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Lundström
- Registercentrum Syd, Region Blekinge, Karlskrona, Sweden
- Department of Clinical Sciences, Ophthalmology, Lund University, Lund, Sweden
| | - Andreas Viberg
- Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden
| | - Anders Behndig
- Registercentrum Syd, Region Blekinge, Karlskrona, Sweden
- Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden
| | - Madeleine Zetterberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden
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Intravitreal injection versus systematic treatment in patients with uveitis undergoing cataract surgery: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2023; 261:809-820. [PMID: 36271933 DOI: 10.1007/s00417-022-05852-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/29/2022] [Accepted: 09/23/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Cataract surgery in patients with uveitis is challenging, and postoperative inflammation control is crucial for successful outcomes. No consensus exists regarding the optimal method of controlling postoperative inflammation. In this systematic review and meta-analysis, we compared the outcome of intravitreal injection (IVI), including steroid (triamcinolone acetonide) or steroid implant (dexamethasone), with systemic anti-inflammatory therapy (ST), such as systemic steroids with or without immunomodulatory therapy, in patients with uveitis undergoing cataract surgery. METHODS We searched PubMed, EMBASE, and Cochrane Library databases for randomized controlled trials (RCTs), comparative cohort studies, and case-control studies published through May 2021 that compared intraoperative IVI of triamcinolone acetonide or steroid implant with ST with or without immunomodulatory therapy. The following outcomes were evaluated: preoperative best-corrected visual acuity, intraocular pressure, laser flare photometry, central macular thickness and cystoid macular edema rate. RESULTS Five studies were selected. Our analysis indicated that compared with ST, IVI treatment may be associated with less anterior chamber inflammation and a lower cystoid macular edema rate, but the difference in best-corrected visual acuity, intraocular pressure, or central macular thickness was not significant. CONCLUSIONS IVI of steroid or steroid implants might be beneficial in controlling postoperative inflammation for uveitis cataract, especially in patients who cannot tolerate ST. To the best of our knowledge, this is the first meta-analysis to compare the efficacy of intraoperative IVI of steroids with standard-of-care treatment as a prophylaxis for uveitis cataract. However, large-scale RCTs are warranted to compare the IVI of steroid implants and steroids.
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6
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Risk of Cataract in Intermediate Uveitis. Am J Ophthalmol 2021; 229:200-209. [PMID: 33713679 DOI: 10.1016/j.ajo.2021.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the incidence of and predictive factors for cataract in intermediate uveitis. DESIGN Retrospective cohort study. METHODS Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study, in which medical records were reviewed to determine demographic and clinical data of every eye/patient at every visit at 5 participating US tertiary care uveitis centers. The primary outcome was development of vision-compromising cataract as defined by a decrease in visual acuity to 20/40 or less, or requiring cataract surgery. Survival analysis assessed visually defined cataract to avoid bias due to timing of surgery vis-à-vis inflammatory status. RESULTS Among 2,190 eyes of 1,302 patients with intermediate uveitis, the cumulative incidence of cataract formation was 7.6% by 1 year (95% confidence interval [CI] = 6.2%-9.1%), increasing to 36.6% by 10 years (95% CI = 31.2%-41.6%). Increased cataract risk was observed in eyes with concurrent anterior uveitis causing posterior synechiae (hazard ratio = 2.68, 95% CI = 2.00-3.59, P < .001), and in eyes with epiretinal membrane formation (hazard ratio = 1.54, 95% CI = 1.15-2.07, P = .004). Higher dose corticosteroid therapy was associated with significantly higher incidence of cataract, especially time-updated use of topical corticosteroids ≥2 times/d or ≥4 periocular corticosteroid injections. Low-dose corticosteroid medications (oral prednisone 7.5 mg daily or less, or topical corticosteroid drops <2 times/d) were not associated with increased cataract risk. CONCLUSIONS Our study found that the incidence of clinically important cataract in intermediate uveitis is moderate. The risk is higher with markers of severity and with higher doses of corticosteroid medications, the latter being potentially modifiable.
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Kempen JH, Van Natta ML, Friedman DS, Altaweel MM, Ansari H, Dunn JP, Elner SG, Holbrook JT, Lim LL, Sugar EA, Jabs DA. Incidence and Outcome of Uveitic Glaucoma in Eyes With Intermediate, Posterior, or Panuveitis Followed up to 10 Years After Randomization to Fluocinolone Acetonide Implant or Systemic Therapy. Am J Ophthalmol 2020; 219:303-316. [PMID: 32628922 DOI: 10.1016/j.ajo.2020.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 05/26/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate long-term risk and outcomes of glaucoma in eyes with intermediate, posterior, and panuveitis managed with systemic or fluocinolone acetonide (0.59 mg, "implant") therapy. DESIGN Prospective Follow-up of the Multicenter Uveitis Steroid Treatment (MUST) Clinical Trial Cohort. METHODS Patients with intermediate, posterior, or panuveitis randomized to implant or systemic therapy (corticosteroid plus immunosuppression in >90%) were followed prospectively for glaucoma incidence and outcome. RESULTS Among 405 uveitic at-risk eyes of 232 patients (median follow-up = 6.9 years), 40% (79/196) of eyes assigned and treated with implant and 8% (17/209) of eyes assigned and treated with systemic therapy (censoring eyes receiving an implant on implantation) developed glaucoma (hazard ratio [HR] = 5.9, 95% confidence interval [CI] 3.2, 10.8; P < .001). Adjustment for intraocular pressure (IOP) elevation during follow-up only partially mitigated the association of implant treatment with glaucoma incidence: HR = 3.1 (95% CI 1.6, 6.0); P = .001. Among 112 eyes of 83 patients developing glaucoma, the 5-year cumulative incidence following diagnosis of sustained (2 or more consecutive visits) worsening of mean deviation by ≥6 dB was 20% (95% CI 12%, 33%); 5-year cumulative incidence of sustained worsening of cup-to-disc ratio by ≥0.2 was 26% (95% CI 17%, 39%). CONCLUSIONS The implant has substantially higher risk of glaucoma than systemic therapy, a difference not entirely explained by posttreatment IOP elevation. Management of IOP elevation was effective in preventing worsening of glaucoma for the large majority of cases, but even under expert clinical management, some glaucoma worsened. Uveitis cases should be monitored carefully for IOP elevation and glaucoma indefinitely.
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Chatterjee S, Agrawal D, Parchand SM, Sahu A. Visual outcome and prognostic factors in cataract surgery in ocular tuberculosis. Indian J Ophthalmol 2020; 68:1894-1900. [PMID: 32823410 PMCID: PMC7690526 DOI: 10.4103/ijo.ijo_428_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To analyze the outcome of cataract surgery in patients with ocular tuberculosis (OTB). Methods: Medical records of patients with OTB who underwent cataract surgery between 2005 and 2018 were retrospectively reviewed. The primary outcome measure was corrected distant visual acuity (CDVA), and a good outcome was defined as CDVA 20/40 or better. Results: There were 35 patients (41 eyes), of whom 13 (37.1%) were males and 22 (62.9%) were females. The mean age was 41.6 ± 13.8 (range 18–65) years. Anterior uveitis was present in 24 (58.5%) eyes, intermediate uveitis in 5 (12.2%) eyes, posterior uveitis in 6 (14.6%) eyes, and panuveitis in 6 (14.6%) eyes. Posterior sub-capsular cataract (51.2%) was the most common type of cataract. Total cataract was present in 9 (22%) eyes. The two most common ocular comorbidities were small pupil (85.4%) and glaucoma (17.1%). Phacoemulsification was performed in 36 (87.8%) eyes and ECCE was performed in 5 (12.2%) eyes. Intraoperatively the pupil was mechanically dilated in 36 (87.8%) eyes. Overall 26 (63.4%) and 23 (56.1%) eyes achieved CDVA 20/40 or better at 1- and 6-month follow-up visit, respectively. The mean preoperative LogMAR CDVA significantly improved from 1.28 ± 0.57 to 0.38 ± 0.36 at 1-month (P < 0.0001). One eye had fibrinous anterior chamber reaction and 24 (58.5%) eyes had 1 or more episodes of reactivation of uveitis in the follow-up period. The three commonest complications were glaucoma (26.8%), posterior capsule opacification (19.5%), and epiretinal membrane (17.1%). Postoperative posterior segment complications like epiretinal membrane formation, vitreous inflammation and cystoid macular edema affected final visual acuity (P < 0.002). Conclusion: The visual outcome after cataract surgery in OTB was satisfactory as significant number of patients achieved a good final visual acuity.
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Affiliation(s)
- Samrat Chatterjee
- Cornea and Anterior Segment Services; Uvea Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Deepshikha Agrawal
- Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Swapnil M Parchand
- Uvea Services; Vitreo-retina Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Anupam Sahu
- Pediatric Ophthalmology and Strabismus Services, MGM Eye Institute, Raipur, Chhattisgarh, India
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9
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Kumar DA, Agarwal A, Ali WRK. Uveitis and deficient lens capsules: Effect of glued intraocular lens on the visual outcome and the reactivation of inflammation. Indian J Ophthalmol 2020; 67:1610-1616. [PMID: 31546491 PMCID: PMC6786213 DOI: 10.4103/ijo.ijo_20_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To evaluate the visual outcome and complication profile after glued intraocular lens (IOL) in post uveitic eyes. Methods: Patients with history of uveitis who had glued IOL with 3 months antecedent quiet anterior chamber (AC) were included in this prospective observational case series. Visual acuity, slit-lamp examination, fundus evaluation, optical coherence tomography, intraocular pressure, specular count and AC inflammation were analyzed before and after glued IOL procedure. Glued IOL eyes were also compared with their fellow normal capsular bag IOL. Results: Overall 17 eyes (50.7 ± 16.1 years) were analyzed. It included 41.8%, 23.5%, and 35.29% anterior, posterior, and pan uveitis, respectively. The etiologies were tuberculosis (23.53%), toxoplasmosis (11.77%), Fuch's heterochromic cyclitis (5.88%), HLA B27 (11.77%), psoriatic arthritis (5.88%), Rheumatoid arthritis (5.8%), sarcoidosis (11.77%), herpetic kerato-uveitis (5.88%), and idiopathic (17.65%). Cataractous subluxated lens (35.3%), aphakia (23.5%), decentered IOL (23.5%) and intraoperative capsular rupture (17.6%) were the surgical indications. A significant improvement in the mean uncorrected and best corrected visual acuity (P < 0.001) was recorded. The complications were IOL pigment dispersion (47%), macular edema (41%), and epiretinal membrane (24%). There was significant rise in AC reaction on day 1 (P < 0.001) and normal AC was attained by 88.2% eyes at 6 months. AC inflammation reactivation was noted in 11.7% of eyes. Though inflammatory reactivation was similar to the normal IOL, macular edema was higher in glued IOL. Conclusion: Glued IOL can cause inflammation in uveitis eyes which can be managed medically with minimal complications.
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Affiliation(s)
- Dhivya Ashok Kumar
- Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
| | - Amar Agarwal
- Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
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Piveta LC, Oliveira HF, Rezende JM, Miguel MP, Lima AMV, Damasceno AD. Intracameral tenecteplase during phacoemulsification in rabbits: clinical assessment of the anterior segment and biochemical analysis of the aqueous humor. CIÊNCIA ANIMAL BRASILEIRA 2020. [DOI: 10.1590/1809-6891v21e-57717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract To evaluate the use of tenecteplase in transoperative phacoemulsification in healthy rabbits, the study was carried out with fifteen New Zealand rabbits, divided into three groups: control group (CG), untreated group (UG) and treated group (TG). UG and TG were operated by phacoemulsification and TG received 50 µg / 0.3 mL of intracameral tenecteplase. The postoperative evaluations were 24 h, 72 h, 7 days, 15 days and 21 days. In TP21 the animals were submitted to euthanasia and aqueous humor samples were collected. No significant differences were observed in the clinical evaluations between CG and TG in relation to incidence rates of intraocular pressure (IOP), corneal edema, fibrin deposits, hyphema, aqueous flare and synechia. In the physicochemical evaluation of the aqueous humor, there were no significant differences between the three groups in relation to pH values and concentrations of chloride ions. The aqueous humor density values were statistically different between CG and the other groups. In the histological evaluation, there were no significant differences between the groups. The use of tenecteplase in transoperative phacoemulsification in rabbits did not present significant differences in terms of clinical, physicochemical and histological parameters.
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Abstract
Uveitis patients represent a unique subset of the population undergoing cataract surgery and pose several challenges that require special consideration and strategy. Maintenance of disease quiescence for at least three months prior to surgery maximizes postoperative outcomes, though these patients remain at increased risk for pseudophakic cystoid macular edema, which can be refractory to the traditional steroid treatments. In this review, we detail the pillars of preoperative optimization, intraoperative considerations, and postoperative management of uveitic cataracts, with special attention on the evidence surrounding prevention and treatment of refractory postoperative cystoid macular edema.
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Affiliation(s)
- Judy L Chen
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pooja Bhat
- Assistant Professor of Ophthalmology, Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ann-Marie Lobo-Chan
- Assistant Professor of Ophthalmology, Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
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Kramer J, Chirco KR, Lamba DA. Immunological Considerations for Retinal Stem Cell Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1186:99-119. [PMID: 31654387 DOI: 10.1007/978-3-030-28471-8_4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is an increasing effort toward generating replacement cells for neuronal application due to the nonregenerative nature of these tissues. While much progress has been made toward developing methodologies to generate these cells, there have been limited improvements in functional restoration. Some of these are linked to the degenerative and often nonreceptive microenvironment that the new cells need to integrate into. In this chapter, we will focus on the status and role of the immune microenvironment of the retina during homeostasis and disease states. We will review changes in both innate and adaptive immunity as well as the role of immune rejection in stem cell replacement therapies. The chapter will end with a discussion of immune-modulatory strategies that have helped to ameliorate these effects and could potentially improve functional outcome for cell replacement therapies for the eye.
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Affiliation(s)
- Joshua Kramer
- Buck Institute for Research on Aging, Novato, CA, USA
| | | | - Deepak A Lamba
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA. .,Buck Institute for Research on Aging, Novato, CA, USA.
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13
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Rana D, Sharma R, Kumar A. Comparative potential of hydrocortisone, deoxycorticosterone and dexamethasone in the prevention of cataract: an in silico and in vitro study. ORIENTAL PHARMACY AND EXPERIMENTAL MEDICINE 2018; 18:403-422. [DOI: 10.1007/s13596-018-0332-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/05/2018] [Indexed: 09/20/2023]
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Leinonen S, Immonen I, Kotaniemi K. Fluocinolone acetonide intravitreal implant (Retisert ® ) in the treatment of sight threatening macular oedema of juvenile idiopathic arthritis-related uveitis. Acta Ophthalmol 2018; 96:648-651. [PMID: 29655222 DOI: 10.1111/aos.13744] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/07/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE We describe eight patients with juvenile idiopathic arthritis-related chronic uveitis, who received a fluocinolone acetonide implant (FAI, Retisert®, Bausch&Lomb) in one eye. All patients had poor visual acuity (VA) due to persistent macular oedema in one or both eyes despite treatment with antirheumatic medication. METHODS Median age of the patients was 22.9 years (range, 14.1-39.7) and duration of uveitis 13.0 years (range, 6.8-28.4) at FAI implantation. Median preoperative best-corrected visual acuity (BCVA) was 0.1 (range, 0.05-0.4) and Standardization of Uveitis Nomenclature, SUN-grade was SUN 2+ (range, 0.5-4.0). All patients had been treated extensively with systemic corticosteroids and antirheumatic drugs by the time of FAI implantation. The median follow-up time was 5.3 years (range, 4.4-6.3). RESULTS Macular edema resolved in a median time of 0.2 years (range, 0.04-0.39) after the FAI implantation. The median BCVA was 0.5-0.63 (range, 0.1-1.0) from 1 to 5 years of follow-up. Macular edema did not recur in 5 eyes after the implantation. In three eyes, the macular oedema relapsed at 2.7, 2.9 and 5.5 years of follow-up. All our patients needed antirheumatic drugs in addition to the FAI to treat their macular edema. During the follow-up, 7 eyes required further intraocular operations: 4 cataract operations, 4 intraocular pressure -lowering operations and 1 retinal detachment surgery were performed. CONCLUSION Fluocinolone acetonide implant is a valuable option in the treatment of persistent macular edema associated with JIA-related uveitis refractory to systemic treatments.
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Affiliation(s)
- Sanna Leinonen
- Department of Ophthalmology; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Ilkka Immonen
- Department of Ophthalmology; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Kaisu Kotaniemi
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
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15
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Squires H, Poku E, Bermejo I, Cooper K, Stevens J, Hamilton J, Wong R, Denniston A, Pearce I, Quhill F. A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults. Health Technol Assess 2018; 21:1-170. [PMID: 29183563 DOI: 10.3310/hta21680] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Non-infectious intermediate uveitis, posterior uveitis and panuveitis are a heterogeneous group of inflammatory eye disorders. Management includes local and systemic corticosteroids, immunosuppressants and biological drugs. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of subcutaneous adalimumab (Humira®; AbbVie Ltd, Maidenhead, UK) and a dexamethasone intravitreal implant (Ozurdex®; Allergan Ltd, Marlow, UK) in adults with non-infectious intermediate uveitis, posterior uveitis or panuveitis. DATA SOURCES Electronic databases and clinical trials registries including MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the World Health Organization's International Clinical Trials Registry Platform were searched to June 2016, with an update search carried out in October 2016. REVIEW METHODS Review methods followed published guidelines. A Markov model was developed to assess the cost-effectiveness of dexamethasone and adalimumab, each compared with current practice, from a NHS and Personal Social Services (PSS) perspective over a lifetime horizon, parameterised with published evidence. Costs and benefits were discounted at 3.5%. Substantial sensitivity analyses were undertaken. RESULTS Of the 134 full-text articles screened, three studies (four articles) were included in the clinical effectiveness review. Two randomised controlled trials (RCTs) [VISUAL I (active uveitis) and VISUAL II (inactive uveitis)] compared adalimumab with placebo, with limited standard care also provided in both arms. Time to treatment failure (reduced visual acuity, intraocular inflammation, new vascular lesions) was longer in the adalimumab group than in the placebo group, with a hazard ratio of 0.50 [95% confidence interval (CI) 0.36 to 0.70; p < 0.001] in the VISUAL I trial and 0.57 (95% CI 0.39 to 0.84; p = 0.004) in the VISUAL II trial. The adalimumab group showed a significantly greater improvement than the placebo group in the 25-item Visual Function Questionnaire (VFQ-25) composite score in the VISUAL I trial (mean difference 4.20; p = 0.010) but not the VISUAL II trial (mean difference 2.12; p = 0.16). Some systemic adverse effects occurred more frequently with adalimumab than with placebo. One RCT [HURON (active uveitis)] compared a single 0.7-mg dexamethasone implant against a sham procedure, with limited standard care also provided in both arms. Dexamethasone provided significant benefits over the sham procedure at 8 and 26 weeks in the percentage of patients with a vitreous haze score of zero (p < 0.014), the mean best corrected visual acuity improvement (p ≤ 0.002) and the percentage of patients with a ≥ 5-point improvement in VFQ-25 score (p < 0.05). Raised intraocular pressure and cataracts occurred more frequently with dexamethasone than with the sham procedure. The incremental cost-effectiveness ratio (ICER) for one dexamethasone implant in one eye for a combination of patients with unilateral and bilateral uveitis compared with limited current practice, as per the HURON trial, was estimated to be £19,509 per quality-adjusted life-year (QALY) gained. The ICER of adalimumab for patients with mainly bilateral uveitis compared with limited current practice, as per the VISUAL trials, was estimated to be £94,523 and £317,547 per QALY gained in active and inactive uveitis respectively. Sensitivity analyses suggested that the rate of blindness has the biggest impact on the model results. The interventions may be more cost-effective in populations in which there is a greater risk of blindness. LIMITATIONS The clinical trials did not fully reflect clinical practice. Thirteen additional studies of clinically relevant comparator treatments were identified; however, network meta-analysis was not feasible. The model results are highly uncertain because of the limited evidence base. CONCLUSIONS Two RCTs of systemic adalimumab and one RCT of a unilateral, single dexamethasone implant showed significant benefits over placebo or a sham procedure. The ICERs for adalimumab were estimated to be above generally accepted thresholds for cost-effectiveness. The cost-effectiveness of dexamethasone was estimated to fall below standard thresholds. However, there is substantial uncertainty around the model assumptions. In future work, primary research should compare dexamethasone and adalimumab with current treatments over the long term and in important subgroups and consider how short-term improvements relate to long-term effects on vision. STUDY REGISTRATION This study is registered as PROSPERO CRD42016041799. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Hazel Squires
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Inigo Bermejo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katy Cooper
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ruth Wong
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Ian Pearce
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Fahd Quhill
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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16
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Macarie SS, Macarie DM. Phacoemulsification in adult patients with post-uveitis complicated cataract. Rom J Ophthalmol 2018; 62:135-137. [PMID: 30206556 PMCID: PMC6117518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective: To evaluate the difficulties, complications and outcome of cataract surgery in patients with complicated cataract after anterior uveitis. Methods: A retrospective study on 37 patients who suffered phacoemulsification surgery for post-uveitis complicated cataract in the period 2009-2014 was performed. 43 eyes underwent surgery. Results: Posterior synechiae were present in 25 eyes. Posterior synechiolysis ensured large pupil in 15 eyes, and, in 14 eyes, the use of iris hooks or pupil expansion ring was necessary for surgery. Posterior capsule rupture was reported in 1 eye. Opacified and thick posterior capsule was noticed in 6 eyes. After surgery, transient rising of intraocular pressure was noticed in 4 eyes and prolonged postoperative inflammation was present in 3 eyes. Posterior capsule opacification was the most frequent issue (9 eyes) and cystoid macular oedema was reported in 2 eyes. Conclusions: Post-uveitis complicated cataract surgery presents specific difficulties and postoperative complications are present in these patients, like prolonged postoperative inflammation and cystoid macular oedema.
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Affiliation(s)
- Sorin Simion Macarie
- Department of Ophthalmology, “Iuliu Hatieganu” University of Medicine
and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Mariana Macarie
- Department of Ophthalmology, Integrated Ambulatory, Clinical
Hospital of Infectious Diseases, Cluj-Napoca, Romania
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Abstract
PURPOSE OF REVIEW This review is timely because the outcomes of surgical invention in uveitic eyes with cataract can be optimized with adherence to strict anti-inflammatory principles. RECENT FINDINGS All eyes should be free of any cell/ flare for a minimum of 3 months preoperatively. Another helpful maneuver is to place dexamethasone in the infusion fluid or triamcinolone intracamerally at the end of surgery. Recent reports about the choice of intraocular lens material or lens design are germane to the best surgical outcome. Integrating these findings will promote better visual outcomes and allow advancement in research to further refine these surgical interventions in high-risk uveitic eyes. SUMMARY Control of inflammation has been shown to greatly improve postoperative outcomes in patients with uveitis. Despite better outcomes, more scientific research needs to be done regarding lens placement and materials and further research needs to adhere to the standardized reporting of uveitis nomenclature. Future studies should improve postoperative outcomes in eyes with uveitis so that they approach those of eyes undergoing routine cataract procedures.
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18
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Gritz DC, Schwaber EJ, Wong IG. Complications of Uveitis: The Northern California Epidemiology of Uveitis Study. Ocul Immunol Inflamm 2017; 26:584-594. [PMID: 28112975 DOI: 10.1080/09273948.2016.1247174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To describe the uveitis complications in a large, community-based cohort. METHODS Retrospective, community-based, cross-sectional cohort study analyzing complications and associations with complications. RESULTS A total of 844 cases of uveitis were found; 342 were new-onset, and 462 were prior-onset. In total, 29.5% of patients were affected by one or more complications associated with age, gender, course, and anatomic location of uveitis. Visual loss was experienced by 19.1% of patients and was associated with age, course of disease, and anatomic location of uveitis. Of the patients who developed glaucoma or elevated intraocular pressure over 30 mmHg, 3.9% (n = 33) were related solely to uveitis; 5.2% (n = 44) had an unclear or combined mechanism; and 1.8% (n = 15) were related solely to steroid response. Cystoid macular edema was associated with course of disease and anatomic location of uveitis. CONCLUSIONS Complications affect a significant portion of uveitis patients, and are often associated with demographic and clinical factors.
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Affiliation(s)
- David C Gritz
- a Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, California, USA.,b University of California, San Francisco , Department of Ophthalmology, Koret Vision Research Center , San Francisco , California , USA.,c The Permanente Medical Group, Kaiser Permanente Oakland Medical Center, Oakland, California, USA.,d Kaiser Permanente Richmond Medical Center , Richmond , California , USA
| | - Eric J Schwaber
- e Tufts University School of Medicine , Boston , Massachusetts , USA
| | - Ira G Wong
- a Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, California, USA.,b University of California, San Francisco , Department of Ophthalmology, Koret Vision Research Center , San Francisco , California , USA.,f Stanford University , Department of Ophthalmology , Stanford , California , USA
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19
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Chu CJ, Dick AD, Johnston RL, Yang YC, Denniston AK. Cataract surgery in uveitis: a multicentre database study. Br J Ophthalmol 2017; 101:1132-1137. [PMID: 28043984 DOI: 10.1136/bjophthalmol-2016-309047] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 11/01/2016] [Accepted: 11/19/2016] [Indexed: 12/17/2022]
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.
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Affiliation(s)
- Colin J Chu
- Academic Unit of Ophthalmology, School of Clinical Sciences and School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.,Bristol Eye Hospital, Bristol, UK
| | - Andrew D Dick
- Academic Unit of Ophthalmology, School of Clinical Sciences and School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.,Bristol Eye Hospital, Bristol, UK.,Institute of Ophthalmology, UCL, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Robert L Johnston
- Gloucestershire Eye Unit, Cheltenham General Hospital, Cheltenham, UK
| | - Yit C Yang
- Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Alastair K Denniston
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Todorich B, Thanos A, Yonekawa Y, Thomas BJ, Abbey AM, Faia LJ. Transconjunctival Sutureless Intrascleral Fixation of Secondary Intraocular Lenses in Patients with Uveitis. Ocul Immunol Inflamm 2016; 26:456-460. [DOI: 10.1080/09273948.2016.1231328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bozho Todorich
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Aristomenis Thanos
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Yoshihiro Yonekawa
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Benjamin J. Thomas
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | | | - Lisa J. Faia
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
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