Adjunct devices for managing challenging cases in cataract surgery: pupil expansion and stabilization of the capsular bag

Dilation devices in cataract surgery

PURPOSE OF REVIEW

Cataract surgery in the setting of small pupil represent a major challenge and it is associated with a higher risk of complications. When pharmacologic pupil dilation fails, mechanical pupil expansion devices are needed to obtain and maintain sufficient intraoperative mydriasis. The purpose of this review is to assess the pupil expansion devices currently available.

RECENT FINDINGS

A variety of pupil expansion devices are offered on the market. They differ for design, material, shape, size, cost, and easiness of insertion/removal, nonetheless they all seem to be effective in improving the pupil size and easing the cataract surgery.

SUMMARY

Mechanical pupil expansion can be effectively achieved with a variety of devices, which are well tolerated and can facilitate cataract surgery in the setting of poor mydriasis.

Evaluation of the Optical Aspects of the Ophthalmic Viscosurgical Device During Femtosecond Laser-Assisted Cataract Surgery

Purpose

In femtosecond laser-assisted cataract surgery (FLACS), capsulorhexis can be performed with an ophthalmic viscosurgical device (OVD) filled in the anterior chamber. We aimed to investigate changes in the laser properties in various optical aspects, such as focal shifting, reflection, and absorption associated with OVD.

Methods

Simulation was achieved by calculating the laser power attenuation due to reflection and spot size change using the Gullstrand eye model. Additionally, we calculated the absorption coefficient by measuring the laser power passing through the OVD with a laser meter and evaluated the effect of absorption by the OVD.

Results

In our simulation, power attenuation due to reflection was a maximum of 0.07%, and power attenuation was 0.08% even when considering the change according to the incident angle. Power attenuation due to the change of the spot size at the focus was 0.005%. Owing to the absorption of the OVD, a power increase of up to 13.5% was required for an anterior chamber depth of 3.0 mm to obtain the same effect as the aqueous humor.

Conclusions

The main reason for laser power attenuation associated with OVD was laser absorption through the OVD, and could also be caused by laser cavitation bubbles. To complete a safe capsulotomy during FLACS, the laser power should be increased appropriately, considering the absorption by the OVD in the anterior chamber.

Translational Relevance

The study results can be applied to calculate the optimal femtosecond laser energy to achieve complete capsulotomy during FLACS in the presence of anterior chamber OVD.

Comparison of different pupil dilatation methods for phacoemulsification in eyes with a small pupil

PURPOSE

To compare 6 methods for intraoperative pupil dilatation in eyes with insufficient pupil size during phacoemulsification.

METHODS

This was a prospective case-control study. 99 microcoria cataract patients (120 eyes) were collected and were divided into 6 groups(20 eyes each group), and their pupils were dilated by bimanual stretching pupil (group I), pupil radial cut open(group II), mechanical pupil dilatation with iris-retractor hooks (group III), OASIS iris expander (group IV), and Malyguin-ring (Microsurgical company, America) (group V), B-HEX Pupil Expander (Med Invent Devics, India)(group VI),respectively. 3.0 mm clear corneal incision were used in phacoemulsification. All cases were followed up at 1 week and 1, 3, 6 months after the surgery. The best corrected visual acuity (BCVA), intraocular pressure(IOP), corneal endothelium cell density(ECD), pupil diameter(PD) of before and after surgery were compared.

RESULTS

One same doctor finished all cataract surgeries successfully. The eyes' condition before surgery and at 6 months after surgery were compared. There were no significant statistical differences for the conditions of the eyes before surgery among six groups. The ECDs were better at 6 months postoperatively in group III and V, median values: 2114/mm², 1961/mm². PD was largest in group II (median value: 5.5 mm), which was significantly larger than other groups (P_adjusted < 0.05).

CONCLUSIONS

All 6 methods used in this study were effective for the mechanical dilatation of small pupils and didn't affect the postoperative visual acuity and intraocular pressure in microcoria cataract phacoemulsification. Iris-retractor hooks and the Malyugin Ring can reduce intraoperative corneal endothelium cell loss. Postoperative PD is larger when the iris was cut open radially.

Pupillary response in adults with Marfan syndrome and its effect on straylight

PURPOSE

The main objective of this study was to examine the pupillary response in patients with Marfan syndrome (MFS) and secondarily to determine whether changes in the pupillary response are associated with the increased disability glare previously shown in the same patient population.

METHODS

This study included 60 eyes of 34 patients with MFS diagnosed in accordance with the Ghent-2 criteria and 81 eyes of 44 controls. Pupillary response was measured with a pupillograph and disability glare with a straylight meter.

RESULTS

The patients with MFS had a significantly smaller maximum pupil size than the control group, 4.87 (4.50-5.23) mm versus 5.58 (5.25-5.90) mm (p = 0.01). In addition, they exhibited slower contraction velocities (p = 0.03) and longer re-dilation times (p = 0.01) compared with the control group. The mean straylight value was higher in patients with MFS than controls, even when including pupillary parameters together with lens surgery, cataract, iris colour, axial length and corneal curvature as possible explanatory variables in the analysis. However, when including data from both groups, a significant negative correlation was seen between maximum pupillary diameter and straylight value (p = 0.01). The other pupillary parameters did not correlate with straylight.

CONCLUSION

Patients with MFS had a smaller maximum pupil diameter, slower pupillary contraction and longer re-dilation time than the controls. Despite the correlation between pupil size and straylight value, the pupillary response demonstrated in MFS eyes could not explain the increased straylight in these patients.

Efficacy of a hinged pupil expansion device in small pupil cataract surgery

Purpose:

To evaluate the efficacy and safety of a hinged pupil expansion device (PED) in eyes with small pupils undergoing phacoemulsification.

Methods:

In this prospective, multicenter, interventional case series of 57 eyes with suboptimal pharmacologic pupil dilation (<5 mm diameter), a hinged PED (I-Ring, Beaver-Visitec International, Waltham, MA) was applied to facilitate surgical visualization during cataract surgery. The pupil diameters (PD) were measured at different stages of the procedure and at the 1-month follow-up visit. Rate of successful intraoperative PED deployment, pupil size, and shape were assessed.

Results:

The mean patient age was 70.5 ± 12.1 years. The I-Ring PED was successfully applied in all eyes. The mean PD at various stages were 4.1 ± 1.1 mm (dilation with eye drops only preoperatively), 4.3 ± 1.1 mm (dilation after intracameral epinephrine and ophthalmic viscoelastic device), 6.80 ± 0.00 mm (with PED applied), and 5.7 ± 1.1 mm (end of surgery). A statistically significant difference (P < 0.001) was observed between the mean PD with intracameral medications and with PED application. Postoperative circular pupil was observed in 54 of 57 eyes (94.7%) and the mean eccentricity index (n = 57 eyes) was 0.11 ± 0.22. No significant adverse events were observed.

Conclusion:

The I-Ring PED safely and effectively provided and maintained adequate pupil expansion and surgical visualization in eyes with small pupils undergoing cataract surgery. Postoperatively 95% of eyes attained circular pupils. This hinged PED is an additional instrumentation option for the safe and effective expansion of inadequately sized pupils during cataract surgery.

Outcomes of first 50 cases using a new pupil expander

PURPOSE

To describe the initial experience with the Assia Pupil Expander 200 (APX-200, APX Ophthalmology) in eyes that underwent phacoemulsification or intraocular lens repositioning surgery that required mechanical pupil expansion.

SETTING

Department of Ophthalmology, Meir Medical Center, Kfar-Saba, and Ein-Tal Eye Center, Tel Aviv, Israel.

DESIGN

Retrospective case series.

METHODS

The APX-200 is a single-use device, intended for mechanical expansion of the pupil during intraocular surgery. Two devices are inserted through 2 opposite 19-gauge incisions using designated forceps. The surgical course and early postoperative follow-up was recorded in 50 eyes.

RESULTS

The study included 50 consecutive eyes, with mean preoperative pupil diameter was 3.7 mm. The APX effectively dilated the pupils in all cases. No complication related to the use of the APX such as hyphema, iridodialysis, or Descemet membrane detachment were noted in this series. A central and round pupil was restored in all eyes at 1-month postoperatively, with 14 eyes (28%) having mild sphincter tears. Pupilloplasty was not required in any of the cases.

CONCLUSIONS

The APX-200 was an effective and safe device for pupil expansion during intraocular surgery.

Intraoperative Complications of Cataract Surgery Using Intracameral Illumination in the Elderly over 75 Years

Purpose

To evaluate intraoperative complications and utilization of adjunctive devices between microscope and intracameral illuminations during cataract surgery in the elderly over 75 years.

Design

A retrospective, consecutive, interventional case series Participants. Two hundred eighty-six eyes of 184 patients older than 75 years who underwent cataract surgery using microscope and intracameral illuminations.

Methods

A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used.

Main Outcome Measures

Intraoperative complications (posterior capsule rupture, radial tear of the anterior capsule, dropped nucleus, or sulcus-implanted/sclera-fixated IOL) and utilization of adjunctive devices (pupil expansion device or anterior capsule staining).

Results

The frequency of use of the pupil expansion device was lower in the advanced cataract surgery group than that in the standard cataract surgery group (0.7% vs 6.9%; p=0.007). Furthermore, the rates of a posterior capsule rupture and at least one intraoperative complication were lower in the advanced cataract surgery group than those in the standard cataract surgery group (0.7% vs 4.8%; p=0.067) (0.7% vs 7.6%; p=0.004).

Conclusions

In the current cohort of patients over 75 years, the rate of intraoperative complications was lower when using the intracameral illumination than that when using the conventional method. Cataract surgery using intracameral illumination would be good option for elderly people.

Iris hooks versus a pupil expansion ring: Operating times, complications, and visual acuity outcomes in small pupil cases

PURPOSE

To compare iris hooks and a pupil expansion ring (Malyugin ring) in eyes with a small pupil.

SETTING

Epsom and St. Helier University National Health Service Trust, London, United Kingdom.

DESIGN

Retrospective case series.

METHODS

Patients who had primary phacoemulsification cataract surgery from January 1, 2012, to December 30, 2016, were included. Combined procedures and surgeons with fewer than 50 cases were excluded. Anonymized data were demographics, surgeon grade, case complexity, iris hooks or Malyugin ring use, posterior capsule rupture, zonular fiber rupture or dialysis, vitreous loss, operating time, postoperative complications, and visual acuity.

RESULTS

Of the 9552 cases included, 425 (4.4%) had a small pupil, 314 of which required a pupil expansion ring and 95 iris hooks. Compared with no pupil expander, iris hooks were associated with an additional operating time of 14 minutes for consultants and 24 minutes for trainees. The pupil expansion ring was associated with an additional operating time of 4 minutes and 6 minutes, respectively. Neither pupil expander was associated with more intraoperative complications. The pupil expansion ring was associated with higher postoperative anterior uveitis and corneal edema rates. Pupil expander cases achieved equivalent visual acuity gains.

CONCLUSIONS

The pupil expansion ring and iris hooks were safe and effective in minimizing intraoperative complications in eyes with a small pupil. The pupil expansion ring was faster to use than iris hooks. Monitoring for signs of postoperative anterior uveitis or cornea edema with careful insertion or removal of pupil expansion rings is advocated.

Capsular bag stabilization during lens extraction and intraocular lens implantation in cases of Marfan syndrome with ectopia lentis using ultra-high-viscosity ophthalmic viscosurgical devices

Capsule-sparing lens surgery in the setting of compromised zonular support presents several surgical challenges. One challenge has been achieving early stabilization of the capsular bag prior to cataract removal. We developed a technique that uses a high-molecular-weight viscoadaptive substance to distend and stabilize the capsular bag from within, with or without early insertion of a capsular tension ring, during lens extraction and intraocular lens (IOL) implantation in cases of zonular insufficiency. The technique obviates the use of capsule hooks or similar devices that have been used traditionally for early stabilization of the capsular bag. It has also resulted in immediate and long-term stability of the IOL-zonule-capsular bag complex, with excellent visual outcomes in both pediatric and adult patients.

FINANCIAL DISCLOSURE

Dr. Rosenthal is a consultant to Abbott Medical Optics, Inc., Ophtec USA, and Bausch & Lomb/Valeant. Dr. Venkateswaran has no financial or proprietary interest in any material or method mentioned.

Numerical stress analysis of the iris tissue induced by pupil expansion: Comparison of commercial devices

Purpose

(1) To use finite element (FE) modelling to estimate local iris stresses (i.e. internal forces) as a result of mechanical pupil expansion; and to (2) compare such stresses as generated from several commercially available expanders (Iris hooks, APX dilator and Malyugin ring) to determine which design and deployment method are most likely to cause iris damage.

Methods

We used a biofidelic 3-part iris FE model that consisted of the stroma, sphincter and dilator muscles. Our FE model simulated expansion of the pupil from 3 mm to a maximum of 6 mm using the aforementioned pupil expanders, with uniform circular expansion used for baseline comparison. FE-derived stresses, resultant forces and area of final pupil opening were compared across devices for analysis.

Results

Our FE models demonstrated that the APX dilator generated the highest stresses on the sphincter muscles, (max: 6.446 MPa; average: 5.112 MPa), followed by the iris hooks (max: 5.680 MPa; average: 5.219 MPa), and the Malyugin ring (max: 2.144 MPa; average: 1.575 MPa). Uniform expansion generated the lowest stresses (max: 0.435MPa; average: 0.377 MPa). For pupil expansion, the APX dilator required the highest force (41.22 mN), followed by iris hooks (40.82 mN) and the Malyugin ring (18.56 mN).

Conclusion

Our study predicted that current pupil expanders exert significantly higher amount of stresses and forces than required during pupil expansion. Our work may serve as a guide for the development and design of next-generation pupil expanders.

Occult lens subluxation related to laser peripheral iridotomy: A case report and literature review

RATIONALE

Laser peripheral iridotomy (LPI) is commonly performed as a primary treatment for acute primary angle closure glaucoma after administration of anti-glaucoma medications or for prevention of this condition. Minor complications may occur following LPI and most of them do not have deleterious consequences. We report a rare case of lens subluxation that has a possible relationship with LPI treatment.

PATIENT CONCERNS

A 54-year-old female patient was initially referred for surgical treatment of medication-uncontrollable angle closure glaucoma in her left eye. The patient had undergone Neodymium:YAG LPI at an outside hospital 2 months prior to the presentation due to an episode of elevated intraocular pressure (IOP). About 5 days after the LPI, she had spontaneous blurred vision, redness, and pain in the left eye. Her IOP was found to re-rise and was not controlled well even with maximum tolerated anti-glaucoma medications during the following 2 months. On slit-lamp examination, the significant shallowing of both peripheral and central anterior chamber was noted in the left eye. Ultrasound biomicroscopy examination revealed the lens tilting towards the iris and the inferior zonular dehiscence corresponding to the iridotomy site.

DIAGNOSES

Lens subluxation secondary to LPI treatment in the left eye.

INTERVENTIONS

Phacoemulsification combined with in-the-bag intraocular lens implantation was performed in the left eye. The zonular weakness corresponding to the iridotomy site was further confirmed during surgery.

OUTCOMES

The patient's IOP remained stable in the first postoperative 3 months without additional anti-glaucoma medications.

LESSONS

Laser peripheral iridotomy may cause structural zonular damage, and ophthalmologists should be aware of this potential complication and proceed with caution.

Causes and management of small pupil in patients with cataract

BACKGROUND

The purpose of the study was to present the causes and management of small pupil (<6 mm) in Greek patients with cataract.

METHODS

About 1144 consecutive patients with cataract comprised the study group. The pupil size was measured after maximal dilation by means of Rosenbaum cards and Colvard pupillometer. Dilation regimen included phenylephrine 10%, tropicamide 1%, cyclopentolate 1%, and ketorolac trometamol 0.5% administered 3 times at 5 min intervals starting 1 h before surgery. The presence of possible risk factors for small pupil was recorded. The need of additional maneuvers and devices to dilate the pupil during cataract surgery was examined, and the complication rate in cases with small pupils was recorded.

RESULTS

Small pupil was observed in 78 out of 1144 eyes (6.8%, 95% confidence interval = 5.2%-8.8%). Nine eyes had pupil size <4 mm (0.78%) preoperatively. Six cases (0.52%) developed intraoperative pupillary miosis. The major cause of small pupil was pseudoexfoliation (PEX) in 47.4% (37/78) of patients. No significant associations were observed regarding age, gender, history of diabetes mellitus, the maturity of cataract, and phacodonesis. Techniques for small pupil management included pupil stretching in 14 cases (17.9%), use of iris hooks in 6 cases (7.7%), iris sphincter cuts in 2 cases (2.6%), and placement of a Malyugin Ring in 4 cases (5.1%). Seven eyes (9%) with small pupil had capsular rupture versus 16 eyes (1.5%) with normal dilation (P < 0.001).

CONCLUSIONS

Small pupil is not very common in Greek population, is mostly caused by PEX, and it is associated with increased complication rate.

New Management Strategies for Ectopia Lentis

Ectopia lentis refers to displacement of the crystalline lens in the setting of various systemic and metabolic disorders. A literature review was conducted to investigate the management of non-traumatic ectopia lentis in the pediatric population, particularly focusing on surgical intervention. Both limbal and pars plana approaches for lensectomy are well established in the literature. Surgical options for intraocular lens implantation in pediatric eyes with ectopia lentis include anterior chamber intraocular lenses and iris-fixated or scleral-fixated posterior chamber intraocular lenses. Recently, the use of capsular tension rings has also been described with promising results. Visual rehabilitation and treatment of amblyopia are essential for patients within the amblyogenic age group following surgical intervention.

The clinical utility of new combination phenylephrine/ketorolac injection in cataract surgery

The maintenance of mydriasis throughout cataract extraction surgery and the control of ocular inflammation are crucial for successful surgical outcomes. The development of miosis during cataract surgery compromises the visualization of the surgical field and working space for surgeons. This may lead to complications that include posterior capsular tear and associated vitreous loss, longer surgical time, and postoperative inflammation. Postoperative inflammation is often uncomfortable and frustrating for patients. It causes pain, redness, and photophobia. This compromises the best-uncorrected vision following surgery and often leads to multiple clinic visits. This article examines the literature published on the current treatments used to manage mydriasis, pain, and inflammation in cataract extraction surgery. Combination phenylephrine/ketorolac injection offers an exciting new class of medication for use in cataract surgery. With the recent approval of Omidria™ (combination of phenylephrine 1% and ketorolac 0.3%) by the US Food and Drug Administration (FDA) for intraocular use, we review the clinical utility of this new combination injection in cataract surgery. PubMed, MEDLINE, and conference proceedings were searched for the relevant literature using a combination of the following search terms: cataract extraction surgery, pupil dilation (mydriasis), miosis, phenylephrine, ketorolac, Omidria™, intracameral mydriatic. Relevant articles were reviewed and their references checked for further relevant literature. All abstracts were reviewed and full texts retrieved where available.

Small Pupil--Big Problem: A Management Algorithm

Small pupils pose problems for cataract surgery. The pupil is dilated with topical mydriatic drugs for all cataract surgeries to improve the surgeon's access to, and visualization of, the lens nucleus, cortex, and capsular structures. Limited dilation poses a risk of surgical complications such as iris trauma or tearing of the anterior or posterior capsule. There are many ways and methods to achieve the appropriate pupil dilation, from pre-operative medications to intraoperative pharmacological and/or surgical methods. A management algorithm for small pupil will be discussed in this review. The various methods and maneuvers may work in isolation or combination to achieve adequate pupil dilation.

Small pupil and cataract surgery

PURPOSE OF REVIEW

Presence of a small pupil is still considered a major challenge for cataract surgeons. Appropriate mydriasis and maintaining it is of paramount importance to prevent potential serious complications. Recently, more interventions and instruments are available for the cataract surgeons to deal with these challenging cases. The intention of this review is to discuss the preoperative and intraoperative considerations and techniques for cataract surgery in small pupil and related conditions and to discuss new developments in management of small pupil in femtosecond laser-assisted cataract surgery.

RECENT FINDINGS

There are new techniques and pharmaceuticals available to cataract surgeons in the setting of small pupil. Intracameral ketorolac may soon be available to maintain mydriasis and to control pain and inflammation. Malyugin ring has been added to pupil expansion rings and has already been used for small pupil in different settings. In femtosecond laser-assisted cataract surgery, presence of a small pupil can now be managed by applying intracameral mydriatics and intraocular devices successfully.

SUMMARY

Accurate preoperative examinations adjunct with intraoperative use of appropriate pharmacologic and mechanical devices can yield favorable outcomes in cataract surgery with a small pupil.

Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions

The maintenance of mydriasis and the control of postoperative pain and inflammation are critical to the safety and success of cataract and intraocular lens replacement surgery. Appropriate mydriasis is usually achieved by topical and/or intracameral administration of anticholinergic agents, sympathomimetic agents, or both, with the most commonly used being cyclopentolate, tropicamide, and phenylephrine. Ocular inflammation is common after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drugs are widely used because they have been proved effective to control postsurgical inflammation and decrease pain. Topical nonsteroidal anti-inflammatory drugs have also been shown to help maintain dilation. However, use of multiple preoperative drops for pupil dilation, inflammation, and pain control have been shown to be time consuming, resulting in delays to the operating room, and they cause dissatisfaction among perioperative personnel; their use can also be associated with systemic side effects. Therefore, ophthalmologists have been in search of new options to streamline this process. This article will review the current medications commonly used for intraoperative mydriasis, as well as pain and inflammation control. In addition, a new combination of ketorolac, an anti-inflammatory agent, and phenylephrine, a mydriatic agent has recently been designed to maintain intraoperative mydriasis and to reduce postoperative pain and irritation from intraocular lens replacement surgery. Two Phase III clinical trials evaluating this combination have demonstrated statistically significant differences when compared to placebo in maintaining intraoperative mydriasis (P<0.00001) and in reducing pain in the early postoperative period (P=0.0002). This medication may be of benefit for use in cataract and lens replacement surgery in the near future.

Laser-assisted cataract surgery following insertion of a pupil expander for management of complex cataract and small irregular pupil

We report a case in which laser-assisted cataract surgery was performed safely and successfully following manual division of posterior synechiae and mechanical dilation of the pupil with a Malyugin ring in a patient with an irregular, small stuck-down pupil.

Intraoperative floppy-iris syndrome

OBJECTIVE

Intraoperative-floppy iris syndrome (IFIS) has been recently described. It has been demonstrated that this new syndrome complicates cataract surgery. In this paper we have reviewed the syndrome, and offer practical information specially related to the origin and management of this syndrome and we offer practical information.

MATERIAL AND METHODS

A review of the related medical literature using PubMed and Cochrane databases. Combining the search terms tamsulosin, cataract, IFIS and intraoperative floppy iris syndrome, more than 200 articles were found. Eighty-two of them were obtained and analysed. In the remaining only the abstract could be studied.

RESULTS

The aetiological association between IFIS and tamsulosin (and to a lesser degree between IFIS and other alpha-antagonists) is well established. Other aetiological associations are doubtful. Most of the literature is centred on cataract surgery. However, a similar syndrome has been described during trabeculectomy. A possible association between these drugs and choroidal detachments has also been described. Undoubtedly tamsulosin treatment makes cataract surgery more difficult and increases the probability of intraoperative complications. Protocols to manage the syndrome have not yet been developed. Intracameral injection of alpha-adrenergic agonists seems to be useful. However there is no evidence of the usefulness of discontinuing the drug or using preoperative mydriatics.

CONCLUSION

The aetiological and clinic features of the syndrome are well established. More studies are needed to provide scientific evidence on the most appropriate way to cope with this syndrome.

Complete spontaneous posterior luxation of capsular bag-intraocular lens-capsular tension ring complex

We describe the case of a monocular 72-year-old man who presented with spontaneous acute visual decrease in the left eye 2 years after uneventful phacoemulsification with intraocular lens (IOL) and standard capsular tension ring (CTR) implantation. Dilated fundoscopy revealed aphakia and complete vitreous luxation of the entire capsular bag-IOL-CTR complex.

Cataract surgery in the setting of uveitis

PURPOSE OF REVIEW

To describe recent evidence from the literature concerning optimal treatment of cataract in patients with concomitant uveitis.

RECENT FINDINGS

Optimal treatment of cataract in the setting of uveitis requires optimal management of uveitis, including appropriate diagnostic workup and scrupulous attention to preoperative preparation, intraoperative technique, and postoperative management. Recent literature suggests high rates of recurrence of certain forms of uveitis (such as ocular toxoplasmosis) after surgery, suggesting that perioperative prophylaxis may be warranted. Placement of intraocular lenses in the setting of certain forms of uveitis, such as juvenile idiopathic arthritis-associated uveitis, remains controversial. Although excellent outcomes can be achieved with many types of intraocular lenses, several recent studies have suggested that the incidence of postoperative complications may be lower in patients receiving acrylic intraocular lenses compared with other materials. Recent long-term outcome studies in cohorts of uveitis patients undergoing cataract surgery suggest very good outcomes in the majority of patients.

SUMMARY

Provided the unique challenges of cataract surgery in the setting of uveitis are recognized and appropriately addressed, excellent visual outcomes can be achieved in most patients.