1
|
Scott RA, Nau SA, Patnaik JL, Le CB, Kolfenbach JR, Palestine AG, Reddy AK. Cataract Surgery Outcomes in Patients with Non-ocular Autoimmune Disease. Ophthalmol Ther 2023; 12:3383-3393. [PMID: 37603160 PMCID: PMC10640514 DOI: 10.1007/s40123-023-00786-x] [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: 06/27/2023] [Accepted: 07/28/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION While phacoemulsification cataract extraction is generally highly effective and safe, patients with a history of uveitis are at higher risk for postoperative complications and often require a modified perioperative medication regimen. No data exists on risks of postoperative complications and persistent anterior uveitis (PAU) in patients with non-ocular autoimmune disease. METHODS Medical records were reviewed of patients who underwent phacoemulsification cataract surgery with intraocular lens implantation between January 1, 2014 and December 31, 2019 at the University of Colorado Hospital (UCH) as part of a retrospective cohort study. Exclusion criteria included patient history of ocular inflammation and cataract surgery combined with another intraocular surgery. Patients were only included as having autoimmune disease if the diagnosis was confirmed by a relevant specialist at UCH. Patients with autoimmune disease were then stratified into systemic versus organ-specific autoimmune disease, and patients with systemic autoimmune disease were further stratified into immunosuppressed and not immunosuppressed at the time of cataract surgery. Patients with PAU were identified according to the Standardization of Uveitis Nomenclature Working Group. Data including sex, race/ethnicity, intraoperative cumulative dissipated energy (CDE), and postoperative best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were obtained. RESULTS A total of 422 eyes from 248 patients had confirmed autoimmune disease, compared to a control group of 10,201 eyes. The autoimmune and systemic autoimmune disease groups were not more likely to have postoperative complications or PAU compared to the control group. Immunosuppression status among the systemic autoimmune disease group was also not associated with postoperative complications or PAU. CONCLUSION Patients with non-ocular autoimmune disease do not appear to be at higher risk for postoperative complications, including worse BCVA or increased rates of IOP elevation and PAU, following phacoemulsification cataract surgery. These patients do not appear to require modification of the typical perioperative medication regimen.
Collapse
Affiliation(s)
- Rachel A Scott
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA
| | - Shane A Nau
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA
| | - Christopher B Le
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA
| | - Jason R Kolfenbach
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA
| | - Amit K Reddy
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA.
| |
Collapse
|
2
|
Bhargava R, Pandey K, Mehta B. Long-term outcomes of small-incision cataract surgery in patients with uveitis. Indian J Ophthalmol 2022; 70:3927-3932. [PMID: 36308129 PMCID: PMC9907274 DOI: 10.4103/ijo.ijo_1571_22] [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: 11/05/2022] Open
Abstract
Purpose To evaluate the long-term outcomes of manual small-incision cataract surgery (MSICS) in eyes with uveitis. Methods Patients who underwent MSICS for uveitic cataract from 2009 to 2019 were retrospectively evaluated. Visually significant cataract and presence of less than five cells per high-power field in the anterior chamber for a minimum of 3 months were the prerequisites for surgery. Patients with follow-up less than 9 months were excluded. Results After exclusion, 283 eyes of 264 patients were evaluated. The mean age of patients was 44.3 ± 11.3 years. The mean follow-up duration was 22 ± 11.5 months. The mean surgical time was 11.2 ± 3.2 min. One hundred and seventy-two eyes (60.8%) had anterior uveitis, 78 (27.5%) had posterior uveitis, and 33 (11.7%) had panuveitis. At the final follow-up, 253 eyes (88.4%) had corrected distance visual acuity (CDVA) better than 0.6 log of minimum angle of resolution (LogMAR) unit. The final endothelial cell counts were significantly (analysis of variance [ANOVA], P = 0.001) lower in eyes with human leukocyte antigen (HLA)-B27-associated uveitis and in eyes with idiopathic anterior uveitis. Patients on systemic corticosteroids had significantly better (P = 0.031) final visual acuity than those without preoperative corticosteroids. Recurrent uveitis (43.8%), Posterior capsule opacification (PCO) (19.4%), glaucoma (8.5%), cystoid macular edema (CME; 13.5%), and Epiretinal membrane (ERM) (5.6%) were the frequent complications. A significantly worse (ANOVA, P = 0.001) visual prognosis was seen in patients with Vogt-Koyanagi-Harada disease (VKH), sarcoidosis, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), and serpiginous choroiditis. Conclusion MSICS is safe in most cataracts due to uveitis and results in improvement in CDVA at 9 months. Posterior capsule opacification, macular edema, persistent uveitis, etiology of uveitis, and use of preoperative steroids significantly influenced the visual outcome.
Collapse
Affiliation(s)
- Rahul Bhargava
- Department of Ophthalmology, GS Medical College and Hospital, Pilkhuwa, Uttar Pradesh, India,Correspondence to: Prof. Rahul Bhargava, Department of Ophthalmology, GS Medical College and Hospital, Pilkhuwa, Uttar Pradesh, India. E-mail:
| | - Kankambari Pandey
- Department of Ophthalmology, Rama Medical College Hospital and Research Centre, Hapur, Uttar Pradesh, India
| | - Bhavya Mehta
- Department of Ophthalmology, GS Medical College and Hospital, Pilkhuwa, Uttar Pradesh, India
| |
Collapse
|
3
|
Anitha V, Madkaikar A, Ravindran M, Siddique MU. Preferred practice of cataract surgery in brown cataract: A questionnaire-based survey among Indian ophthalmic surgeons. Indian J Ophthalmol 2022; 70:3893-3897. [PMID: 36308122 PMCID: PMC9907254 DOI: 10.4103/ijo.ijo_1555_22] [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: 11/05/2022] Open
Abstract
Purpose To determine the most preferred method of operating brown cataracts among ophthalmologists in India. Methods A cross-sectional, questionnaire-based study was conducted among ophthalmologists all over India through electronic and social media from May 1 to June 15, 2022. All single, voluntary entries within the stipulated time period were accepted for analysis. Results A total of 230 ophthalmologists participated in the study among which 198 (86%) preferred Manual small-incision cataract surgery (mSICS) as the first option. This was preferred due to the high risk of complications associated (40, 33.6%) as well as endothelial damage due to increased Phaco power (53, 47.9%). The majority of the surgeons (162, 70.4%) preferred a superior tunnel for SICS, and 51.7% (119) performed continuous curvilinear capsulorhexis in 100% of their cases. The most common complication encountered was posterior capsular rupture (PCR) (66%), followed by zonular dialysis (ZD) (18.7%), whole bag removal (8.3%), and Descemet's membrane detachment (7%). Conclusion Despite diverse recent new modalities of Femto Laser assisted cataract surgery (FLACS). Phakonit, and Smart Intraocular Lens (IOLs), the majority of ophthalmologists still find the manual small-incision cataract surgery (mSICS) procedure a safe surgery for mature brown cataracts.
Collapse
Affiliation(s)
- Venugopal Anitha
- Cornea, Ocular Surface, Trauma and Refractive Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India,Correspondence to: Dr. Venugopal Anitha, Cornea, Ocular Surface, Trauma and Refractive Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India. E-mail:
| | - Aditee Madkaikar
- Cornea and Refractive Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Meenakshi Ravindran
- Paediatrics and Strabismology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Mohammed Uduman Siddique
- Biostatistics, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| |
Collapse
|
4
|
Tejaswini A, Gurnani B, Kaur K, Sinha A, Bejjenki P, Jella N, Morya AK. Commentary: Evaluating affordability, cost-effectiveness, cost-utility, health economics, and incremental cost-effectiveness ratio of manual small-incision cataract surgery - The need of the hour. Indian J Ophthalmol 2022; 70:3771-3772. [PMID: 36308094 PMCID: PMC9907234 DOI: 10.4103/ijo.ijo_2232_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Antarvedi Tejaswini
- Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Bharat Gurnani
- Cataract, Cornea, External Disease, Trauma, Ocular Surface and Refractive Surgery, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - Kirandeep Kaur
- Cataract, Pediatric Ophthalmology and Strabismus, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | | | - Priyanka Bejjenki
- Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Niharika Jella
- Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Arvind Kumar Morya
- Cataract, Glaucoma, Refractive, Squnt, Paediatric Ophthalmology and Medical Retina Services, All India Institute of Medical Sciences Bibinagar, Hyderabad, Telangana, India,Correspondence to: Dr. Arvind Kumar Morya, Cataract, Glaucoma, Refractive, Squint, Pediatric Ophthalmology and Medical Retina Services, Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad - 508 126, Telangana, India. E-mail:
| |
Collapse
|
5
|
Ravindra MS, Singh S, Meda KR, Meda DR. Manual small-incision cataract surgery under topical anesthesia for post-uveitis complicated cataract. Indian J Ophthalmol 2022; 70:3923-3926. [PMID: 36308128 PMCID: PMC9907239 DOI: 10.4103/ijo.ijo_1609_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Cataract development is a common sequelae associated with uveitis. Despite phacoemulsification being the popular method of cataract surgery today, manual small-incision cataract surgery (MSICS) may still be a safe and effective alternative because of several inherent benefits. There is not much literature and studies on the efficacy and safety of MSICS under topical anesthesia in complicated cataract in patients with uveitis. We aimed to study the safety and visual outcome of MSICS under topical anesthesia for post uveitis complicated cataract. Methods This was a retrospective observational study. The electronic medical records of adult patients who underwent MSICS under topical anesthesia for post uveitis cataract were reviewed. The records were reviewed and analyzed for preoperative clinical characteristics and visual acuity, intraoperative complications and postoperative visual acuity, and complications. Results A total of 71 eyes of 59 patients were taken for final analysis. The average age of patients was 59.9 years. There was improvement in the best corrected visual acuity by 0.7 logMAR (P value <0.0001). Average follow-up period was 9.8 months. The mean gain in visual acuity in eyes that received preoperative steroids was 0.6 logMAR compared to the eyes that did not receive steroids (0.71 logMAR). The difference was not statistically significant (P = 0.407). Complications seen during long-term follow-up were recurrence (15.5%), cystoid macular edema (7%), Epiretinal membrane (8.5%), and posterior capsular opacification (5.5%). Conclusion With proper technique and precautions, MSICS can be safely and comfortably performed under topical anesthesia even in complicated cataracts with excellent visual and safety outcomes.
Collapse
Affiliation(s)
- Meda S Ravindra
- Department of Cataract and Refractive Surgery, Karthik Netralaya Institution of Opthalmology, Bengaluru, Karnataka, India
| | - Sonia Singh
- Department of Vitreo-Retina and Uvea, Karthik Netralaya Institution of Opthalmology, Bengaluru, Karnataka, India,Correspondence to: Dr. Sonia Singh, Karthik Netralaya, 89, 7th Cross Rd, Near Bull Temple Road, CK Nagar, NR Colony, Basavanagudi, Bengaluru - 560 050, Karnataka, India. E-mail:
| | - Karthik R Meda
- Department of Vitreo-Retina and Uvea, Karthik Netralaya Institution of Opthalmology, Bengaluru, Karnataka, India
| | - Deepthi R Meda
- Department of Cataract and Refractive Surgery, Karthik Netralaya Institution of Opthalmology, Bengaluru, Karnataka, India
| |
Collapse
|
6
|
Gurnani B, Mishra D, Kaur K, Heda A, Sahu A. Evolution of manual small-incision cataract surgery from 8 mm to 2 mm - A comprehensive review. Indian J Ophthalmol 2022; 70:3773-3778. [PMID: 36308095 PMCID: PMC9907246 DOI: 10.4103/ijo.ijo_1567_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cataract is the most common cause of reversible blindness worldwide, accounting for approximately 50% of blindness worldwide. Cataract surgery is the most common surgical procedure performed in routine ophthalmic practice. It has undergone tremendous evolution, and the incision size has progressively reduced from 10-12 mm in extracapsular cataract surgery (ECCE) to 6-8 mm for manual small-incision cataract surgery (MSICS) and 2.2-2.8 mm in phacoemulsification. In a developing country like India, with a massive backlog of cataract, everyone cannot afford private surgery like phacoemulsification. Moreover, annual maintenance of the machine, cost of foldable IOLs, need for greater skill, learning curve, and difficulty in performing the surgery in mature and brown cataracts are other barriers. Due to these factors, MSICS is the surgery of choice in the developing world, with profound societal and economic benefits and similar visual recovery compared to phacoemulsification. During the last two decades, MSICS gained popularity in developing countries and has undergone tremendous advances. This article aims to review the various techniques of MSICS and how the surgery has evolved over the years, particularly focusing on the current technique of 2-mm MSICS.
Collapse
Affiliation(s)
- Bharat Gurnani
- Consultant Cataract, Cornea and Refractive Services, Amritsar, Punjab, India
| | - Deepak Mishra
- Associate Professor, Department of Ophthalmology, Regional Institute of Ophthalmology, Banaras Hindu University, Varanasi, Uttar Pradesh, India,Correspondence to: Dr. Deepak Mishra, Associate Professor, Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. E-mail:
| | - Kirandeep Kaur
- Consultant Cataract, Pediatric Ophthalmology and Strabismus Services, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - Aarti Heda
- Consultant Glaucoma, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Amulya Sahu
- Department of Ophthalmology, Sahu Eye Hospital and Kamal Nethralay Pvt Ltd, Mumbai, Maharashtra, India
| |
Collapse
|
7
|
Shoughy SS, Jaroudi MO, Tabbara KF. Incidence of posterior capsule opacification following phacoemulsification in patients with uveitis. Saudi J Ophthalmol 2021; 34:182-185. [PMID: 34085010 PMCID: PMC8081085 DOI: 10.4103/1319-4534.310414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/07/2020] [Accepted: 07/25/2020] [Indexed: 12/03/2022] Open
Abstract
PURPOSE: The purpose of this study was to evaluate the incidence of posterior capsule opacification (PCO) in patients with inactive uveitis who underwent phacoemulsification with acrylic hydrophobic intraocular lens. METHODS: Thus was a retrospective review of 25 consecutive patients (31 eyes) with uveitis who underwent phacoemulsification. A group of 100 patients (140 eyes) without uveitis served as historical controls. RESULTS: In patients with uveitis, PCO occurred in 11 eyes (35.5%), 6 (19%) of which were visually significant and required treatment with neodymium-doped yttrium aluminum garnet (Nd: YAG) laser. In the control group, PCO developed in 17 (12%) eyes which required treatment with Nd: YAG laser. The incidence of PCO was significantly higher in uveitis patients compared to the control group (P = 0.001), but the incidence of visually significant PCO requiring laser capsulotomy was not statistically significant (P = 0.3). CONCLUSION: The incidence of PCO in patients with uveitis was significantly higher than those without uveitis, but the need for Nd: YAG laser capsulotomy for visually significant PCO was not statistically significant.
Collapse
Affiliation(s)
- Samir S Shoughy
- The Eye Center and the Eye Foundation for Research in Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud O Jaroudi
- The Eye Center and the Eye Foundation for Research in Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | - Khalid F Tabbara
- The Eye Center and the Eye Foundation for Research in Ophthalmology, King Saud University, Riyadh, Saudi Arabia.,Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
8
|
Porwal AC, Mathew BC, Abhishek P. Surgeon fatigue: A factor in intraoperative complications in high volume tertiary eye care center. Indian J Ophthalmol 2021; 69:1634-1635. [PMID: 34011761 PMCID: PMC8302286 DOI: 10.4103/ijo.ijo_3578_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Amit C Porwal
- Department of Glaucoma, Choithram Netralaya, Indore, Madhya Pradesh, India
| | - Bennet C Mathew
- Department of Ophthalmology, Choithram Netralaya, Indore, Madhya Pradesh, India
| | - Patel Abhishek
- Department of Community Ophthalmology, Choithram Netralaya, Indore, Madhya Pradesh, India
| |
Collapse
|
9
|
Kolli H, Evers C, Murray PI. Nd:YAG Laser Posterior Capsulotomy in Adult Patients with Uveitis. Ocul Immunol Inflamm 2020; 29:1537-1539. [PMID: 32255718 DOI: 10.1080/09273948.2020.1738500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To study the complication rate of Nd:YAG laser posterior capsulotomy in patients with uveitis.Method: Retrospective case note analysis of pseudophakic uveitis patients having undergone Nd:YAG laser posterior capsulotomy between January 2016 and December 2018. Complications documented included uveitis flare, raised intraocular pressure, intraocular lens damage/displacement, cystoid macular edema, and retinal detachment.Results: There were 39 eyes of 38 patients (20M, 18F; age 27-89 years). Mean interval between cataract surgery and laser was 55 months (range 8-286 months). Mean laser energy was 79 mJ (range 33-207 mJ). At 3 months 62% of eyes achieved a 2-5 Snellen line improvement that was maintained at 12 months. Vision was unchanged in 21% of eyes due to preexisting pathology, with no eyes having worse vision. No post-laser complications were documented.Conclusions: Nd:YAG laser posterior capsulotomy is a safe procedure in uveitis patients, resulting in a good improvement in vision.
Collapse
Affiliation(s)
- Hema Kolli
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Charlotte Evers
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Philip I Murray
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
10
|
Abstract
Uveitis is a leading causes of blindness worldwide, and the development of cataracts is common due to both the presence of intraocular inflammation and the most commonly employed treatment with corticosteroids. The management of these cataracts can be very challenging and often requires additional procedures that can compromise surgical results. The underlying disease affects a relatively young population at higher risk of complications. Preoperative control of inflammation/quiescent disease for at least three months is generally accepted as the minimum amount of time prior to surgical intervention. Phacoemulsification with intraocular lens is the preferred method for surgery, with some studies showing improvement in visual acuity in over 90% of patients. The most common postoperative complications include macular edema, posterior capsule opacification, recurrent or persistent inflammation, glaucoma, epiretinal membrane and IOL deposits, or dislocation. Despite the potential complications, cataract surgery in uveitis patients is considered a safe and successful procedure.
Collapse
Affiliation(s)
- Stephanie M Llop
- a Uveitis and Ocular Immunology Service , Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School , Boston , MA , USA
| | - George N Papaliodis
- a Uveitis and Ocular Immunology Service , Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School , Boston , MA , USA
| |
Collapse
|