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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 2023:1-6. [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] [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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Yoeruek E, Deuter C, Gieselmann S, Saygili O, Spitzer MS, Tatar O, Bartz-Schmidt KU, Szurman P. Long-Term Visual Acuity and its Predictors after Cataract Surgery in Patients with Uveitis. Eur J Ophthalmol 2018; 20:694-701. [DOI: 10.1177/112067211002000409] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose. To analyze the outcomes of phacoemulsification and posterior intraocular lens (IOL) implantation in patients with uveitis and to determine factors responsible for poor visual outcome. Methods. The records of 155 patients (180 eyes) with uveitis who had phacoemulsification and IOL implantation between August 2001 and March 2008 were examined retrospectively. Best-corrected visual acuity (BCVA) was recorded at the immediate preoperative visit and at follow-up examinations every 3 months. At each postoperative visit, a complete ophthalmologic examination was performed. The postoperative visual outcomes and complications were analyzed. Univariate regression analysis was done to determine risk factors for poor visual acuity during follow-up. Results. The mean follow-up was 31.4 months (range 3–78 months). An underlying systemic disease was present in 70 (45.2%) patients (82 eyes, 45.6%). The mean preoperative logMAR BCVA was 1.13±0.62 (95% CI: 0.85–1.02) and increased to 0.42±0.57 (95% CI: 0.32–0.59) at last medical visit (p<0.001). A total of 107 eyes (59.4%) had postoperative complications including posterior capsular opacification, newly developed macular edema, recurrence of uveitis, macular epiretinal membrane, and deposits on the IOL surface. Preoperatively observed macular lesions was the factor most strongly associated with poor visual outcome after cataract surgery (odds ratio: 5.43; 95% CI: 3.41–7.34; p<0.001). Anterior segment pathologies, age at surgery, etiology of uveitis (idiopathic, uveitis associated systemic disease), and gender did not influence visual rehabilitation after surgery (p>0.05). Conclusions. The outcomes of phacoemulsification and IOL implantation in patients with uveitis were satisfactory. Patients with observed preoperative macular lesions are at risk for poor visual outcome.
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Affiliation(s)
- Efdal Yoeruek
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Christoph Deuter
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Sylvia Gieselmann
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Oguzhan Saygili
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Martin S. Spitzer
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Olcay Tatar
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Karl U. Bartz-Schmidt
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Peter Szurman
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
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Secchi A. Cataract Surgery in Exudative Uveitis: Effectiveness of Total Lens Removal, Anterior Vitrectomy, and Scleral Fixation of PC Iols. Eur J Ophthalmol 2018; 18:220-5. [DOI: 10.1177/112067210801800209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose 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. Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- A.G. Secchi
- Department of Ophthalmology, University of Padova, Padova - Italy
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Abstract
The visual outcome of uveitic cataract surgery depends on the underlying uveitic diagnosis, the presence of vision-limiting pathology and perioperative optimization of disease control. A comprehensive preoperative ophthalmic assessment for the presence of concomitant ocular pathology, with particular emphasis on macula and optic nerve involvement, is essential to determine which patients will benefit from improved vision after cataract surgery. Meticulous examination in conjunction with adjunct investigations can help in preoperative surgical planning and in determining the need for combined or staged procedures. The eye should be quiescent for a minimum of 3 months before cataract surgery. Perioperative corticosteroid prophylaxis is important to reduce the risk of cystoid macular edema and recurrence of the uveitis. Antimicrobial prophylaxis may also reduce the risk of reactivation in eyes with infectious uveitis. Uveitic cataracts may be surgically demanding due to the presence of synechiae, membranes, and pupil abnormalities that limit access to the cataract. This can be overcome by manual stretching, multiple sphincterotomies or mechanical dilation with pupil dilation devices. In patients <2 years of age and in eyes where the inflammation is poorly controlled, intraocular lens implantation should be deferred. Intensive local and/or oral steroid prophylaxis should be given postoperatively if indicated. Patients must be monitored closely for disease recurrence, excessive inflammation, raised intraocular pressure, hypotony, and other complications. Complications must be treated aggressively to improve visual rehabilitation. With proper patient selection, improved surgical techniques and optimization of peri- and post-operative care, patients with uveitic cataracts can achieve good visual outcomes.
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Affiliation(s)
| | - Seng-Ei Ti
- Singapore National Eye Centre, Singapore 168751, Singapore
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Abbouda A, Tortorella P, Restivo L, Santoro E, De Marco F, La Cava M. Follow-Up Study of Over Three Years of Patients with Uveitis after Cataract Phacoemulsification: Outcomes and Complications. Semin Ophthalmol 2015; 31:532-41. [PMID: 25700154 DOI: 10.3109/08820538.2015.1009554] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the rate and onset of intraoperative and postoperative complications post-phacoemulsification. METHODS One hundred sixty-two eyes of 145 patients with uveitis who underwent phacoemulsification between 2006 and 2009 were identified through surgical record review. Fifty-nine eyes of 46 patients met the inclusion criteria. Hazard ratio (HR) and Kaplan-Meier survival probability were calculated for each class of uveitis. RESULTS Macular edema (ME) resulted to be associated to chronic postoperative inflammation (r = 0.6; p = 0.00) and mostly related to patients who presented more than one postoperative relapse/year (r = 0.2; p = 0.02). Fuchs uveitis resulted to be a risk factor for posterior capsule opacification (PCO) (HR 3.36 IC95%1.0-10.5; p = 0.03). Hypotony and elevated intraocular pressure (IOP) were detected in the anterior uveitis group (0.02 EY). CONCLUSION The HR to develop ME was significantly related to chronic anterior uveitis. PCO and elevated IOP are most frequent in Fuchs uveitis. The postoperative visual acuity result was good among all the uveitis groups.
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Affiliation(s)
- Alessandro Abbouda
- a Department of Ophthalmology , University of Rome "Sapienza" , Rome , Italy
| | - Paolo Tortorella
- a Department of Ophthalmology , University of Rome "Sapienza" , Rome , Italy
| | - Lucia Restivo
- a Department of Ophthalmology , University of Rome "Sapienza" , Rome , Italy
| | - Elisa Santoro
- a Department of Ophthalmology , University of Rome "Sapienza" , Rome , Italy
| | - Federica De Marco
- a Department of Ophthalmology , University of Rome "Sapienza" , Rome , Italy
| | - Maurizio La Cava
- a Department of Ophthalmology , University of Rome "Sapienza" , Rome , Italy
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Mehta S, Linton MM, Kempen JH. Outcomes of cataract surgery in patients with uveitis: a systematic review and meta-analysis. Am J Ophthalmol 2014; 158:676-692.e7. [PMID: 24983790 DOI: 10.1016/j.ajo.2014.06.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE To critically assess the evidence base regarding outcomes following cataract surgery in uveitic cases. DESIGN Systematic evidence-based review and meta-analysis. METHODS A comprehensive search query was performed on MEDLINE, EMBASE, CINHAL, and CENTRAL databases. Relevant publications were identified by reviewing query results and reference list searches. RESULTS A total of 89 articles met eligibility criteria. Among uveitic eyes with quiet or mostly quiet uveitis before cataract surgery, 20/40 visual acuity or better (≥20/40) was achieved in 68% following phacoemulsification, 72% following extracapsular cataract extraction, and 40% following pars plana lensectomy. More eyes undergoing cataract surgery with intraocular lens (IOL) implantation than eyes left aphakic achieved ≥20/40 postoperatively (71% vs 52%). Eyes receiving acrylic IOLs or heparin-surface-modified (HSM) polymethylmethacrylate had better visual outcomes than those receiving non-HSM polymethylmethacrylate or silicone IOLs. Active uveitis at the time of cataract surgery was associated with worse visual outcomes. Compared with other uveitis cases, the proportion achieving 20/40 or better post cataract surgery was better for Fuchs heterochromic cyclitis cases and worse for uveitis related to Behçet disease, Vogt-Koyanagi-Harada disease, or sympathetic ophthalmia, and also posterior uveitis in general. CONCLUSION Cataract surgery in eyes with uveitis resulted in normal range levels of visual acuity in most cases. The review suggests that preoperative control of uveitis, use of an acrylic or HSM IOL, and a diagnosis of Fuchs heterochromic cyclitis were associated with better outcomes. Posterior-involving uveitides tended to do worse, likely because of vision-limiting complications of uveitis. Average results may not be applicable to specific clinical scenarios.
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Suelves AM, Siddique SS, Schurko B, Foster SC. Anterior chamber intraocular lens implantation in patients with a history of chronic uveitis: Five-year follow-up. J Cataract Refract Surg 2014; 40:77-81. [DOI: 10.1016/j.jcrs.2013.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 06/24/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
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Suelves AM, Kruh JN, Aznar-Peña I, Siddique SS, Foster SC. Long-term safety and visual outcomes of anterior chamber intraocular lens implantation in patients with a history of chronic uveitis. J Cataract Refract Surg 2012; 38:1777-82. [DOI: 10.1016/j.jcrs.2012.05.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/15/2012] [Accepted: 06/16/2012] [Indexed: 10/27/2022]
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Phacoemulsification with intraocular lens implantation in patients with uveitis. J Cataract Refract Surg 2010; 36:1283-8. [DOI: 10.1016/j.jcrs.2010.02.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Revised: 02/03/2010] [Accepted: 02/23/2010] [Indexed: 11/21/2022]
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Roesel M, Heinz C, Koch JM, Heiligenhaus A. Comparison of orbital floor triamcinolone acetonide and oral prednisolone for cataract surgery management in patients with non-infectious uveitis. Graefes Arch Clin Exp Ophthalmol 2010; 248:715-20. [PMID: 20082200 DOI: 10.1007/s00417-009-1269-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 11/24/2009] [Accepted: 12/07/2009] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare orbital floor triamcinolone acetonide and oral prednisolone in cataract surgery in patients with chronic non-infectious uveitis with regard to visual outcome, postoperative inflammation and macular edema. METHODS Monocentric prospective randomized clinical trial with 40 eyes included. Patients underwent phacoemulsification with intraocular acrylic foldable lens (IOL) implantation. Patients were randomized either to intraoperative orbital floor triamcinolone acetonide (TA) (1 ml = 40 mg) (group 1, n = 20), or to 4-week postoperative oral prednisolone (group 2, n = 20). Laser flare photometry (LFM), cells in the anterior chamber (AC), best-corrected visual acuity (BCVA), IOL cell deposits, cystoid macular edema (CME) by means of fluorescein angiography, and central foveal thickness (OCT), posterior capsule opacification (PCO), and intraocular pressure (IOP) were analysed during a 6-months period. RESULTS Mean BCVA postoperatively improved (p < 0.01) from logMAR 0.74 and 0.86 to 0.23 and 0.35 in groups 1 and 2 respectively.The number of AC cells, LFM and IOL cell deposits did not differ. Macular edema stayed unchanged in most cases in both groups, and mean foveal thickness (OCT) initially increased postoperatively, but after 6 months it nearly returned to baseline thickness. Differences between the groups were not significant. Up to 12% in group 1 and 28% of group 2 developed IOP elevation over 21 mmHg. CONCLUSIONS A single intraoperative orbital floor injection of triamcinolone acetonide is as effective on postoperative inflammation, macular edema, and visual outcome as a 4-week course of postoperative oral prednisolone in cataract surgery with IOL implantation in uveitis patients.
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Affiliation(s)
- Martin Roesel
- Department of Ophthalmology at St. Franziskus Hospital, Muenster, University Duisburg-Essen, Hohenzollernring 74, 48145 Muenster, Germany
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Lobo AM, Papaliodis GN. Perioperative evaluation and management of cataract surgery in uveitis patients. Int Ophthalmol Clin 2010; 50:129-137. [PMID: 20057302 DOI: 10.1097/iio.0b013e3181c5539d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Ann-Marie Lobo
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
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Roesel M, Tappeiner C, Heinz C, Koch JM, Heiligenhaus A. Comparison between intravitreal and orbital floor triamcinolone acetonide after phacoemulsification in patients with endogenous uveitis. Am J Ophthalmol 2009; 147:406-12. [PMID: 19054496 DOI: 10.1016/j.ajo.2008.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Revised: 09/04/2008] [Accepted: 09/05/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the effect of intravitreal and orbital floor triamcinolone acetonide (TA) on macular edema, visual outcome, and course of postoperative inflammation after cataract surgery in uveitis patients. DESIGN Prospective, randomized clinical trial. METHODS Monocenter study (40 patients) with chronic endogenous uveitis who underwent phacoemulsification with intraocular lens implantation with either 4 mg intravitreal TA (n = 20) or 40 mg orbital floor TA (n = 20). The primary outcome was influence on cystoid macular edema (CME). Secondary outcome measures were best-corrected visual acuity (BCVA), anterior chamber cell grade, laser flare photometry, giant cell deposition, posterior capsule opacification (PCO), and intraocular pressure. RESULTS Mean central foveal thickness decreased in the intravitreal TA group and increased in the orbital floor TA group (P < .001 at one and three months). CME improved in 50% of patients after intravitreal TA, whereas it was unchanged after orbital floor TA (difference between the groups at three months, P = .049). Mean BCVA (logarithm of the minimal angle of resolution) improved postoperatively (P < .001) from 0.76 and 0.74 to 0.22 and 0.23 in the intravitreal TA and orbital floor TA group, respectively. Anterior chamber cell count at one month was lower in the intravitreal TA than in the orbital floor TA group (P = .02). Laser flare photometry values and giant cell numbers were slightly higher after orbital floor TA than after intravitreal TA. The groups did not differ with respect to PCO rate and ocular hypertension. CONCLUSIONS The CME improvement and anti-inflammatory effect after intravitreal TA was better than after orbital floor TA injection in cataract surgery in uveitis patients.
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Affiliation(s)
- Martin Roesel
- Department of Ophthalmology, St Franziskus-Hospital, Muenster, Germany
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Uveal and capsular biocompatibility of two foldable acrylic intraocular lenses in patients with endogenous uveitis--a prospective randomized study. Graefes Arch Clin Exp Ophthalmol 2008; 246:1609-15. [PMID: 18642021 DOI: 10.1007/s00417-008-0886-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 06/08/2008] [Accepted: 06/10/2008] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND To compare a hydrophobic and a hydrophilic acrylic single-piece intraocular lens (IOL) in uveitis patients with respect to biocompatibility and visual outcome. METHODS Prospective, randomized study in patients with noninfectious uveitis after phacoemulsification and implantation of either a hydrophobic AcrySof (group 1, n = 30) or a hydrophilic Akreos adapt (group 2, n = 30), sharp-edged acrylic IOL. The primary outcome was uveal biocompatibility, detected by giant-cell deposition, anterior chamber cell count and laserflare photometry over a 6-month follow-up period. Secondary outcome measures were capsular biocompatibility, as detected by posterior capsule opacification (PCO), lens epithelial cell outgrowth and Nd:YAG capsulotomies, and visual outcome. RESULTS The groups did not differ with respect to anatomic type of uveitis, immunosuppressive treatment, associated systemic disease, and intraoperative manipulation. The number of giant cells on the anterior IOL surface was higher in group 1 than in group 2 (p = 0.03). The number of anterior chamber cells, laser flare photometry levels, and uveitis reactivations after surgery did not differ between the groups. After 6 months, the number of patients with PCO development (p = 1.0) and Nd:YAG capsulotomies (p = 0.21), lens epithelial cell outgrowth, visual outcome and uveitis complications were comparable in both groups. CONCLUSIONS Both of the acrylic IOLs used had good uveal and capsular biocompatibility, leading to significant improvement in BCVA in patients with noninfectious uveitis. No obvious differences were detected at 6 months with respect to uveal and capsular biocompatibility and visual outcome.
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Bibliography. Current world literature. Neuro-ophthalmology. Curr Opin Ophthalmol 2006; 17:574-5. [PMID: 17065928 DOI: 10.1097/icu.0b013e32801121a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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