1
|
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.
Collapse
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
| |
Collapse
|
2
|
Kalogeropoulos D, Lotery AJ, Gupta B, Lash S, Antonakis S. Epiretinal membranes in patients with uveitis: an update on the current state of management. Int Ophthalmol 2024; 44:291. [PMID: 38940960 PMCID: PMC11213727 DOI: 10.1007/s10792-024-03199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up, and therapeutic approach of uveitic epiretinal membranes (ERM). METHODS A thorough investigation of the literature was conducted using the PubMed database. Additionally, a complementary search was carried out on Google Scholar to ensure the inclusion of all relevant items in the collection. RESULTS ERM is an abnormal layer at the vitreoretinal interface, resulting from myofibroblastic cell proliferation along the inner surface of the central retina, causing visual impairment. Known by various names, ERM has diverse causes, including idiopathic or secondary factors, with ophthalmic imaging techniques like OCT improving detection. In uveitis, ERM occurrence is common, and surgical intervention involves pars plana vitrectomy with ERM peeling, although debates persist on optimal approaches. CONCLUSIONS Histopathological studies and OCT advancements improved ERM understanding, revealing a diverse group of diseases without a unified model. Consensus supports surgery for uveitic ERM in progressive cases, but variability requires careful consideration and effective inflammation management. OCT biomarkers, deep learning, and surgical advances may enhance outcomes, and medical interventions and robotics show promise for early ERM intervention.
Collapse
Affiliation(s)
- Dimitrios Kalogeropoulos
- Southampton Eye Unit, University Hospital Southampton, Tremona Road, Hampshire, Southampton, SO16 6YD, UK
| | - Andrew John Lotery
- Southampton Eye Unit, University Hospital Southampton, Tremona Road, Hampshire, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Bhaskar Gupta
- Southampton Eye Unit, University Hospital Southampton, Tremona Road, Hampshire, Southampton, SO16 6YD, UK
| | - Stephen Lash
- Southampton Eye Unit, University Hospital Southampton, Tremona Road, Hampshire, Southampton, SO16 6YD, UK
| | - Serafeim Antonakis
- Southampton Eye Unit, University Hospital Southampton, Tremona Road, Hampshire, Southampton, SO16 6YD, UK.
| |
Collapse
|
3
|
Shekhar M, Chaudhary S, Pai A, Rajesh V, Balakrishnan L, Nagu K, Wijesinghe HK. Visual outcomes and risk factors of uveitis cataract eyes after phacoemulsification and manual small-incision cataract surgery. J Cataract Refract Surg 2024; 50:257-263. [PMID: 37885121 PMCID: PMC10878458 DOI: 10.1097/j.jcrs.0000000000001354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To examine the visual outcomes and risk factors of uveitis cataract eyes after phacoemulsification and manual small-incision cataract surgery (MSICS). SETTING Tertiary-care eye hospital in southern India. DESIGN Retrospective interventional case series. METHODS Of the uveitis eyes operated for cataract surgery between 2017 and 2020, eyes with a minimum of 6 months postoperative follow-up were included. Eyes with ocular trauma, lens subluxation, lens-induced uveitis, or retinal detachment-induced uveitis were excluded. Demography, visual acuity, intraoperative and postoperative records, and surgical outcomes were analyzed. RESULTS 191 eyes of 191 patients with a mean age of 51.7 ± 14.4 years were included. Phacoemulsification was performed in 134 eyes, and 57 eyes underwent MSICS. Synechiolysis and pupil-expanding maneuvers were required in 74 eyes (38.7%). No differences were noted in the rates of complications between phacoemulsification and MSICS eyes, except at 1 year, where higher rates of posterior capsular opacification and vitritis were noted in MSICS eyes ( P = .018). The visual outcomes of eyes that underwent MSICS and phacoemulsification were comparable ( P = .463). In 12 eyes (13.5%), improvement in vision was not significant. CONCLUSIONS This study shows phacoemulsification may be a preferred technique in uveitis cataracts, given the lesser incidence of postoperative complications. Patients should be counseled for realistic expectations.
Collapse
Affiliation(s)
- Madhu Shekhar
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| | - Sushmita Chaudhary
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| | - Aruna Pai
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| | - Vedhanayaki Rajesh
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| | - Logesh Balakrishnan
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| | - Kamatchi Nagu
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| | - Hiruni Kaushalya Wijesinghe
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| |
Collapse
|
4
|
Lin X, Ma D, Yang J. Exploring anterion capsular contraction syndrome in cataract surgery: insights into pathogenesis, clinical course, influencing factors, and intervention approaches. Front Med (Lausanne) 2024; 11:1366576. [PMID: 38439904 PMCID: PMC10911763 DOI: 10.3389/fmed.2024.1366576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Anterior capsular contraction syndrome (ACCS) is a challenging complication that can occur following phacoemulsification cataract surgery. Characterized by capsular bag wrinkling, intraocular lens (IOL) decentration and tilt, ACCS can have negative effects on visual outcomes and patient satisfaction. This review aims to investigate the pathogenesis, clinical course, influencing factors, and intervention approaches for ACCS after cataract surgery. By understanding the underlying mechanisms and identifying factors that contribute to ACCS, surgeons can enhance their ability to predict and manage this complication. Various intervention strategies are discussed, highlighting their importance in reducing complications and improving surgical outcomes. However, further research is needed to determine optimal prevention and management strategies through long-term follow-up and comparative analyses. Advancements in this field will ultimately lead to improved visual outcomes and optimized cataract surgery for patients.
Collapse
Affiliation(s)
- Xuanqiao Lin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Dongmei Ma
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jin Yang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| |
Collapse
|
5
|
Thng ZX, Putera I, Testi I, Chan K, Westcott M, Chee SP, Dick AD, Kempen JH, Bodaghi B, Thorne JE, Barisani-Asenbauer T, de Smet MD, Smith JR, McCluskey P, La Distia Nora R, Jabs DA, de Boer JH, Sen HN, Goldstein DA, Khairallah M, Davis JL, Rosenbaum JT, Jones NP, Nguyen QD, Pavesio C, Agrawal R, Gupta V. The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 1-global current practice patterns for the management of Herpes Simplex Virus and Varicella Zoster Virus anterior uveitis. Eye (Lond) 2024; 38:61-67. [PMID: 37419957 PMCID: PMC10764303 DOI: 10.1038/s41433-023-02630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023] Open
Abstract
AIMS To present current expert practice patterns and to formulate a consensus for the management of HSV and VZV AU by uveitis specialists worldwide. METHODS A two-round online modified Delphi survey with masking of the study team was conducted. Responses were collected from 76 international uveitis experts from 21 countries. Current practices in the diagnosis and treatment of HSV and VZV AU were identified. A working group (The Infectious Uveitis Treatment Algorithm Network [TITAN]) developed data into consensus guidelines. Consensus is defined as a particular response towards a specific question meeting ≥75% of agreement or IQR ≤ 1 when a Likert scale is used. RESULTS Unilaterality, increased intraocular pressure (IOP), decreased corneal sensation and diffuse or sectoral iris atrophy are quite specific for HSV or VZV AU from consensus opinion. Sectoral iris atrophy is characteristic of HSV AU. Treatment initiation is highly variable, but most experts preferred valacyclovir owing to simpler dosing. Topical corticosteroids and beta-blockers should be used if necessary. Resolution of inflammation and normalisation of IOP are clinical endpoints. CONCLUSIONS Consensus was reached on several aspects of diagnosis, choice of initial treatment, and treatment endpoints for HSV and VZV AU. Treatment duration and management of recurrences varied between experts.
Collapse
Affiliation(s)
- Zheng Xian Thng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilaria Testi
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Kevin Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Mark Westcott
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew D Dick
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
- University of Bristol, Bristol, UK
- UCL Institute of Ophthalmology, London, UK
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School, and Schepens Eye Research Institute, Boston, MA, USA
- Sight for Souls, Fort Myers, FL, USA
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Bahram Bodaghi
- Department of Ophthalmology, IHU FOReSIGHT, Sorbonne-APHP, 47-83 bd de l'Hopital, 75013, Paris, France
| | - Jennifer E Thorne
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Talin Barisani-Asenbauer
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Marc D de Smet
- Department of Ophthalmology, Leiden University, Leiden, The Netherlands
- MIOS sa, Lausanne, Switzerland
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, SA, Australia
- Queensland Eye Institute, Brisbane, QLD, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Douglas A Jabs
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joke H de Boer
- Department of Ophthalmology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Debra A Goldstein
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James T Rosenbaum
- Oregon Health and Science University, Portland, OR, USA
- Legacy Devers Eye Institute, Portland, OR, USA
| | - Nicholas P Jones
- School of Biological Sciences, University of Manchester, Manchester, UK
| | | | - Carlos Pavesio
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
- University of Bristol, Bristol, UK
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Duke NUS Medical School, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| |
Collapse
|
6
|
Vergroesen JE, Thee EF, de Crom TOE, Kiefte-de Jong JC, Meester-Smoor MA, Voortman T, Klaver CCW, Ramdas WD. The inflammatory potential of diet is associated with the risk of age-related eye diseases. Clin Nutr 2023; 42:2404-2413. [PMID: 37865012 DOI: 10.1016/j.clnu.2023.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND & AIMS Inflammation is involved in the pathogenesis of cataract, age-related macular degeneration (AMD), and possibly open-angle glaucoma (OAG). We assessed whether the inflammatory potential of diet (quantified using the dietary inflammatory index; DII) affects the incidence of these common blinding age-related eye diseases. Serum inflammation markers were investigated as possible mediators. METHODS Participants aged >45 years were selected from the prospective, population-based Rotterdam Study. From 1991 onwards, every 4-5 years, participants underwent extensive eye examinations. At baseline, blood samples and dietary data (using food frequency questionnaires) were collected. The DII was adapted based on the data available. Of the 7436 participants free of eye diseases at baseline, 4036 developed incident eye diseases during follow-up (cataract = 2895, early-intermediate AMD = 891, late AMD = 81, OAG = 169). RESULTS The adapted DII (aDII) ranged from -4.26 (i.e., anti-inflammatory) to 4.53 (i.e., pro-inflammatory). A higher aDII was significantly associated with increased inflammation. A higher neutrophil-lymphocyte ratio (NLR) was associated with an increased risk of cataract and AMD. Additionally, complement component 3c (C3c) and systemic immune-inflammation index (SII) were associated with increased risks of cataract and late AMD, respectively. Every point increase in the aDII was associated with a 9% increased risk of cataract (Odds ratio [95% confidence interval]: 1.09 [1.04-1.14]). The NLR and C3c partly mediated this association. We also identified associations of the aDII with risk of AMD (early-intermediate AMD, OR [95% CI]: 1.11 [1.03-1.19]; late AMD, OR [95% CI]: 1.24 [1.02-1.53]). The NLR partly mediated these associations. The aDII was not associated with OAG. CONCLUSIONS A pro-inflammatory diet was associated with increased risks of cataract and AMD. Particularly the NLR, a marker of subclinical inflammation, appears to be implicated. These findings are relevant for patients with AMD and substantiate the current recommendations to strive for a healthy lifestyle to prevent blindness.
Collapse
Affiliation(s)
- Joëlle E Vergroesen
- Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Eric F Thee
- Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; EyeNED Reading Center, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Tosca O E de Crom
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Jessica C Kiefte-de Jong
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands.
| | - Magda A Meester-Smoor
- Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, P.O. Box 17 6700 AA Wageningen, the Netherlands.
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; EyeNED Reading Center, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Ophthalmology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands; Institute of Molecular and Clinical Ophthalmology, University of Basel, CH-4031 Basel, Switzerland.
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| |
Collapse
|
7
|
Jevnikar K, Počkar S, Umek L, Rothova A, Valentincic NV. Prognostic factors of cataract surgery in patients with uveitis. Int Ophthalmol 2023; 43:4605-4612. [PMID: 37697081 PMCID: PMC10724088 DOI: 10.1007/s10792-023-02860-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/20/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To evaluate the long-term visual outcomes of patients with uveitis undergoing cataract surgery and to identify possible factors influencing the visual prognosis and the development of postoperative complications. METHODS Retrospective study of all patients with uveitis who underwent cataract surgery between January 2015 and February 2020 in our tertiary referral center. RESULTS A total of 78 eyes from 78 patients were included in the study. The best-corrected visual acuity (BCVA) improved in 86% of patients, and a BCVA of 0.5 or better was achieved in 57 (73%) patients. A significant correlation was shown between the preoperative and postoperative BCVA (Spearman r = 0.521, p < 0.01). Final BCVA differed between diverse anatomical uveitis entities (p = 0.047), and anterior uveitis demonstrated the best outcomes. Chronic uveitis resulted in a worse final BCVA than acute recurrent uveitis (p = 0.001). The presence of CME any time before the surgery and intermediate uveitis were associated with worse visual prognosis, while systemic therapy for uveitis before surgery and iris manipulation during surgery were not related to visual outcomes. Postoperative development of cystoid macular edema (CME) was closely associated with preexisting CME (p < 0.001) and intermediate uveitis (p = 0.01). CONCLUSIONS Visual results of cataract surgery in patients with uveitis were beneficial, but limited visual outcomes were more frequently observed in patients with chronic uveitis and intermediate uveitis with a history of CME. In consequence, prevention, or adequate treatment of CME, especially in patients with intermediate uveitis, might result in better visual results of their cataract surgery.
Collapse
Affiliation(s)
- Kristina Jevnikar
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia
| | - Saša Počkar
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Lan Umek
- Faculty of Public Administration, University of Ljubljana, Ljubljana, Slovenia
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Natasa Vidovic Valentincic
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| |
Collapse
|
8
|
Deng J, Sun WT, Ai H, Wang LP. Combination of cataract surgery with intravitreal injection of dexamethasone intravitreal implant (Ozurdex) for uveitis-induced cataract. Int J Ophthalmol 2023; 16:361-366. [PMID: 36935789 PMCID: PMC10009600 DOI: 10.18240/ijo.2023.03.05] [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: 01/16/2022] [Accepted: 05/29/2022] [Indexed: 03/06/2023] Open
Abstract
AIM To evaluate the long-term results of patients with chronic uveitis-induced cataract by phacoemulsification with IOL implantation and intravitreal injection of dexamethasone (DEX) intravitreal implant (Ozurdex). METHODS The study included 32 eyes of 26 patients treated with DEX implant due to chronic uveitis-induced cataract and followed up for at least a year. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber reaction, central macular thickness (CMT), intraoperative and postoperative complications and uveitis recurrence were analyzed retrospectively. RESULTS A successful surgery was performed in all patients. The average follow-up period was 12mo. The female/male ratio was 13/13. Mean age was 45.65±3.83y (range 26 to 65y). Etiologically, rheumatic arthritis occurred in 6 patients (18.75%), ankylosing spondylitis in 4 (12.50%), HLA-B27 associated uveitis in 3 (9.38%), Vogt-Koyanagi-Harada-associated uveitis in 4 (12.50%) , Behcet's disease in 2 (6.25%), and 7 (21.88%) suffered from unknown diseases. All 32 eyes had varying degrees of improvement at 12mo after surgery, with 2 eyes showing BCVA of 0.1 or below (6.25%), 6 having 0.1-0.5 (18.75%), 18 of 0.5-1.0 (56.25%), and 6 of 1.0 or above (18.75%). No cases with increased IOP were observed. The values of mean CMT was increased at day 1, decreased at 1, 3mo after surgery and increased at 6, 12mo after surgery. No severe uveitis reactions, such as fibrinous exudates in the anterior chamber and exudative membrane formation on the anterior surface of the IOL, were observed after surgery. CONCLUSION The present studies show that intravitreal injection of Ozudex during cataract operation can provide a new option for the clinical treatment of uveitis-induced cataract.
Collapse
Affiliation(s)
- Jin Deng
- Xi'an People's Hospital (Xi'an Fouth Hospital), Shaanxi Eye Hospital, Affiliated People's Hospital of Northwest University, Xi'an 710004, Shaanxi Province, China
| | - Wen-Tao Sun
- Xi'an People's Hospital (Xi'an Fouth Hospital), Shaanxi Eye Hospital, Affiliated People's Hospital of Northwest University, Xi'an 710004, Shaanxi Province, China
| | - Hua Ai
- Xi'an People's Hospital (Xi'an Fouth Hospital), Shaanxi Eye Hospital, Affiliated People's Hospital of Northwest University, Xi'an 710004, Shaanxi Province, China
| | - Li-Ping Wang
- Xi'an People's Hospital (Xi'an Fouth Hospital), Shaanxi Eye Hospital, Affiliated People's Hospital of Northwest University, Xi'an 710004, Shaanxi Province, China
| |
Collapse
|
9
|
Kalogeropoulos D, Asproudis I, Stefaniotou M, Moschos MM, Kozobolis VP, Voulgari PV, Katsanos A, Gartzonika C, Kalogeropoulos C. The Large Hellenic Study of Uveitis: Diagnostic and Therapeutic Algorithms, Complications, and Final Outcome. Asia Pac J Ophthalmol (Phila) 2023; 12:44-57. [PMID: 36588192 DOI: 10.1097/apo.0000000000000594] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/20/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The purpose of this study is to present the diagnostic and therapeutic algorithms, complications, and final outcome in the management of uveitic patients at a tertiary academic referral center. DESIGN Observational study. METHODS Analysis of the archives of 6191 uveitic patients at the Ocular Inflammation Service of the Department of Ophthalmology of the University Hospital of Ioannina in Greece from 1991 to 2020. RESULTS During the 30 years of the study, the diagnostic ability climbed from 45.43% (1991-1995) to 73.4% (2016-2020). This improvement was linked to several factors including the increase in the number of diagnostic paracenteses for the analysis of intraocular fluids, the range and quality of laboratory blood tests, the multimodal ophthalmic imaging, the proper use of nonophthalmic imaging, and the multidisciplinary approach. The degree of uveitis-related complications was related to the severity and cause of inflammation, the recurrence rate, inappropriate treatment, and the prolonged or initially inactive inflammation. The 3 most common complications included cataract, macular edema, and glaucoma. Apart from the modern treatments and surgical techniques, the 3-month preoperative control of inflammation played a critical role in the surgical outcomes. The percentage of patients with a successful outcome increased from 72% (2001-2005) to 90.50% (2016-2020). The center's experience, prompt referral, patient's compliance, and regular follow-ups are associated with a better outcome. The analysis of the results allowed the development of diagnostic and therapeutic algorithms. CONCLUSIONS Developing diagnostic and therapeutic algorithms allows for the efficient management of uveitis, leading to better visual outcome and therefore a better quality of life.
Collapse
Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Ioannis Asproudis
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Maria Stefaniotou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Marilita M Moschos
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios P Kozobolis
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Patras, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Andreas Katsanos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Constantina Gartzonika
- Laboratory of Microbiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| |
Collapse
|
10
|
Cataract Surgery in Uveitis: Risk Factors, Outcomes, and Complications. Am J Ophthalmol 2022; 244:117-124. [PMID: 36002071 DOI: 10.1016/j.ajo.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To determine the outcomes of cataract surgery in eyes with uveitis, including the rates of intraoperative and postoperative complications, as well as predictors of visual outcomes. DESIGN Retrospective observational cohort study. METHODS Setting: Tertiary public hospital setting in Auckland, New Zealand, between 2008 and 2020. STUDY POPULATION Patients who underwent cataract surgery following a diagnosis of uveitis.Main observation Procedures: Additional intraoperative procedures, intraoperative and postoperative complications, and postoperative visual outcomes and complications. RESULTS 471 eyes of 371 subjects were included. Median duration of uveitis prior to cataract surgery was 3.0 years (interquartile range [IQR] 5.2) and median period of quiescence prior to surgery was 1.0 years (IQR 1.5). Additional procedures (posterior synechiae peel [32.3%] and vision blue [18.1%]) were common. Intraoperative complications occurred in 32 eyes (6.8%). Consultants were the primary surgeons in the majority (82.5%) of operations. By 12 months, visual acuity was 20/50 or better in 248 eyes (79.7%). The most common postoperative complication was uveitis flare, occurring in 56.5%. On Cox proportional hazards analysis, time quiescent was associated with reduced risk of flare (HR 0.794, P = .003). Postoperative cystoid macular edema (CME) developed in 45 eyes (9.6%), with no significant predictors identified on multivariate analysis. CONCLUSIONS Cataract surgery in uveitis is complex. In the hands of the surgically experienced, rates of intraoperative complications are low. The primary challenge is managing postoperative care as we report a high rate of uveitis relapse and CME. Careful monitoring is important as complications can be unpredictable and occur later than expected.
Collapse
|
11
|
Sepulveda-Beltran PA, Levine H, Gibbons AG, Maharaj A, Choi DS, Martinez JD, Correa ZM, Amescua G, Harbour JW. Post-Radiation Cataract Management: Outcomes in Individuals with Uveal Melanoma. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00304-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Blanchard C, O’Keefe G. Peri and Postoperative Management of Cataract Surgery in Eyes with Ocular Inflammation. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
13
|
Kumcu ND, Balikoglu-Yilmaz M, Ozgul S, Imre SS. Anterior Segment Parameters after Uveitic Cataract Surgery: A Prospective Study with 1-Year Results. Photodiagnosis Photodyn Ther 2022; 37:102736. [DOI: 10.1016/j.pdpdt.2022.102736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
|
14
|
Nien CW, Lee CY, Chen HC, Chao SC, Hsu HJ, Tzeng SH, Yang SJ, Huang JY, Yang SF, Lin HY. The elevated risk of sight-threatening cataract in diabetes with retinopathy: a retrospective population-based cohort study. BMC Ophthalmol 2021; 21:349. [PMID: 34587923 PMCID: PMC8480064 DOI: 10.1186/s12886-021-02114-y] [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] [Received: 03/12/2021] [Accepted: 09/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background The effect of diabetic retinopathy (DR) on the development of sight-threatening cataracts was assessed using the National Health Insurance Research Database of Taiwan. Methods Patients diagnosed with diabetes mellitus (DM) and DR were enrolled in the study group. Age- and sex-matched DM individuals without DR and patients without DM served as the DM control group and non-DM control group, respectively, both with 1:4 ratios. The outcome was set as the performance of cataract surgery. Cox proportional hazard regression was used to calculate the adjusted hazard ratio (aHR) of DR considering multiple factors underlying cataract formation. Results A total of 3297 DR patients, 13,188 DM control patients and 13,188 non-DM control subjects were enrolled. The study group included 919 events of sight-threatening cataracts (27.87%), the DM control group included 1108 events (8.40%), and the non-DM control group included 957 events (7.26%). A multivariable analysis indicated that the study group presented a higher aHR of cataract surgery (2.93, 95% CI: 2.60–3.30) and a higher cumulative probability of cataract surgery than both the DM control and non-DM control groups (both log rank P < 0.001). In addition, both the proliferative DR (3.90, 95% CI: 3.42–4.45) and nonproliferative DR (2.35, 95% CI: 2.08–2.65) subgroups showed a higher aHR of cataract surgery than the DM control group. Conclusion The presence of DR increases the risk of sight-threatening cataracts that warrant surgery, and the effect is prominent among patients with both proliferative DR and nonproliferative DR.
Collapse
Affiliation(s)
- Chan-Wei Nien
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan.,Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Chun Chao
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan.,Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Hung-Jui Hsu
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan.,Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Shih-Hao Tzeng
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shang-Jung Yang
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University and School of Medicine, Zhonghe, Taiwan.,College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan. .,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Hung-Yu Lin
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan. .,Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan. .,Department of Optometry, Chung Shan Medical University, Taichung, Taiwan. .,College of Medicine, National Chung Hsing University, Taichung, Taiwan.
| |
Collapse
|
15
|
Testi I, Addison P, Nolan W, Pavesio C. Severe Hypotony-induced Intraocular Inflammation after Removal of Ripcord Suture from a Glaucoma Drainage Device in Uveitis Patient. Ocul Immunol Inflamm 2021; 30:1547-1549. [PMID: 33830861 DOI: 10.1080/09273948.2021.1903936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To report a case of exuberant anterior chamber inflammation post partial removal of supramid® stent.Methods: Case report.Results: The sudden intraocular pressure drop induced by partial removal of ripcord suture from a glaucoma drainage device can result in blood-retinal and blood-aqueous barrier breakdown, inducing uveitis.Conclusions: Intensive inflammatory prophylaxis prior to maneuvers to reduce intraocular pressure may reduce the risk of severe intraocular inflammation in patients with a previous history of uveitis as a consequence of sudden hypotony.
Collapse
Affiliation(s)
- Ilaria Testi
- Department of Uveitis, Moorfields Eye Hospital National Health Service Foundation Trust, London, UK
| | - Peter Addison
- Department of Uveitis, Moorfields Eye Hospital National Health Service Foundation Trust, London, UK
| | - Winifred Nolan
- Department of Glaucoma, Moorfields Eye Hospital National Health Service Foundation Trust, London, UK
| | - Carlos Pavesio
- Department of Uveitis, Moorfields Eye Hospital National Health Service Foundation Trust, London, UK
| |
Collapse
|
16
|
Marchese A, Bandello F. Current Challenges in the Postoperative Management of Cataract Surgery. Ophthalmology 2021. [DOI: 10.17925/opht.2021.15.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
17
|
Srushti DS, Anilkumar SE, Kanakath AV, Narendran K. Surgical handling of uveitic membranes in pediatric phakic eyes. Indian J Ophthalmol 2020; 68:1967-1968. [PMID: 32823439 PMCID: PMC7690517 DOI: 10.4103/ijo.ijo_2357_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- D S Srushti
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Sasikala Elizabeth Anilkumar
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Anuradha Vadakke Kanakath
- Uvea Clinic, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Kalpana Narendran
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| |
Collapse
|
18
|
July consultation #4. J Cataract Refract Surg 2020; 46:1059-1060. [DOI: 10.1097/01.j.jcrs.0000694664.06264.3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Improving the View in Vitreoretinal Surgery. Int Ophthalmol Clin 2020; 60:91-101. [PMID: 32576726 DOI: 10.1097/iio.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Jiang L, Wan W, Xun Y, Xiong L, Wu B, Xiang Y, Li Z, Zhu L, Ji Y, Yang P, Hu K. Effect of hypothermic perfusion on phacoemulsification in cataract patients complicated with uveitis: a randomised trial. BMC Ophthalmol 2020; 20:232. [PMID: 32546211 PMCID: PMC7298810 DOI: 10.1186/s12886-020-01507-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate the effectiveness and safety of hypothermic perfusion in the phacoemulsification of cataract caused by uveitis. Methods This was a prospective, single-masked, randomised, controlled clinical trial. One hundred and six patients with uveitis-associated cataract underwent phacoemulsification with perfusion fluid temperature at 4 °C (treatment group) or 24 °C (control group). Anterior chamber inflammation grade, corneal endothelial cell count, corneal thickness, macular fovea thickness, and intraocular pressure (IOP) were observed on the 1st day and 7th day after operation. Results The aqueous flare score was 0.83 ± 0.76 in the 4 °C group, which was lower than that in the 24 °C group (1.51 ± 1.02, p = 0.006) on the first day after operation. The aqueous cells score was lower in the 4 °C group (0.17 ± 0.38) than that in the 24 °C group (0.62 ± 0.94, p = 0.025). The mean corneal thickness of incision in the 4 °C group (907.66 ± 85.37 μm) was thinner than that in the 24 °C group (963.75 ± 103.81 μm, p = 0.005). Corneal endothelial cells density, macular fovea thickness, or percentage of transiently increased IOP showed no difference between the two groups (p > 0.05). There was no significant difference in all the main outcome parameters between the two groups on the 7th day after operation (p > 0.05). Conclusions Hypothermic perfusion in the phacoemulsification of uveitis-associated cataract is safe, and it can effectively inhibit anterior chamber inflammation and reduce the incisional corneal edema in the early postoperative stage. Trial registration The study was registered with the Chinese Clinical Trial Registry. (http://www.chictr.org.cn/, Registration Number: ChiCTR1800016145).
Collapse
Affiliation(s)
- Lu Jiang
- Chongqing Medical University, Chongqing, China
| | - Wenjuan Wan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Yan Xun
- Chongqing Medical University, Chongqing, China
| | - Liang Xiong
- Chongqing Medical University, Chongqing, China
| | - Binge Wu
- The Second affiliated hospital of Baotou medical college, Baotou, Inner Mongolia Autonomous Region, China
| | | | - Zhouyu Li
- Chongqing Medical University, Chongqing, China
| | - Lu Zhu
- Chongqing Medical University, Chongqing, China
| | - Yan Ji
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Ke Hu
- Chongqing Medical University, Chongqing, China. .,The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China.
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Garweg JG. [Pharmacological treatment strategies and surgical options for uveitis]. Ophthalmologe 2019; 116:942-950. [PMID: 30796601 DOI: 10.1007/s00347-019-0870-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] [Indexed: 10/27/2022]
Abstract
BACKGROUND Modern treatment of uveitis aims at a complete control of inflammatory activity, preservation of visual function and the prevention of secondary organ damage as a consequence of the underlying inflammatory disease and its treatment. OBJECTIVE This article gives an update about the strategies of pharmacological and surgical options for uveitis. MATERIAL AND METHODS The outcomes reported here are based on a PubMed search using the terms <"uveitis" AND "therapy"> and <"uveitis" AND "surgery" OR "surgical treatment">. All prospective studies and case series with more than 20 cases as well as review articles from the last 5 years along with cited cross-references were evaluated. RESULTS Local and systemic corticosteroids form the foundation of treatment after exclusion of an infectious etiology. If uveitis activity is not controlled within 6 weeks or if the daily corticosteroid dosage is unacceptably high, a treatment escalation using immunomodulatory drugs is required. If a complete control of inflammatory activity is not achieved, in a third phase treatment is supplemented by antibody-based treatment or cytokines, so-called biologics, with the aim of complete long-term freedom from disease without local or systemic steroid treatment. This target is achieved in 65-80% and guarantees long-term functional stability and anatomical integrity. Early treatment escalation in cases of persisting or recurrent activity as a rule prevents new secondary organ damage. Surgical options are utilized for diagnostic purposes, the administration of intravitreal drugs and for treatment of secondary complications. CONCLUSION Just like the majority of immunological diseases, uveitis is a chronic disease requiring long-term and possibly lifelong treatment and remission (absence of inflammation without treatment) is achieved in only <20%. Surgical interventions can be performed with a good prognosis, if the optic nerve head and macula are not involved. They have a substantially lower complication rate when freedom from symptoms exists preoperatively for at least 3 months.
Collapse
Affiliation(s)
- Justus G Garweg
- Berner Augenklinik am Lindenhofspital, Affiliation: Klinik und Poliklinik für Augenheilkunde, Inselspital, Universität Bern, Bremgartenstr 119, 3012, Bern, Schweiz. .,Swiss Eye Institute, Rotkreuz, Schweiz.
| |
Collapse
|
23
|
Do systemic steroids increase the risk of ocular complication in uveitis patients? Focus on a Italian referral center. Clin Rheumatol 2019; 38:2917-2923. [PMID: 31172366 DOI: 10.1007/s10067-019-04585-3] [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: 02/15/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To describe the ocular inflammatory and iatrogenic complications in a cohort of uveitic patients treated in an Italian referral centre. MATERIAL AND METHODS Retrospective non-comparative case series. Medical history and clinical findings of all consecutive patients referred to the uveitis center of Pisa University from January 2015 to January 2017 were reviewed. Only patients with at least three follow-up visits in our center were included in our series. RESULTS Three hundred and eighty-nine patients were visited in our center during study period; only 142 patients (90 men and 52 female) satisfied the inclusion criteria. Mean age at presentation was 41 ± 14 years. The most common ocular feature was anterior uveitis (46%) and was mainly unilateral. A specific etiological diagnosis was established in 61% of patients. At presentation, 71.43% of patients were on medical therapy for rheumatic disease; 42.86% of patients used systemic steroids Cataract and ocular hypertension were the most common ocular complications during the study period but were not statistically related to systemic steroid treatment. CONCLUSIONS Systemic steroids treatment in uveitis patients does not seem to increase the risk of iatrogenic complications such as cataract and glaucoma. In our series, increasing age appears to be the main risk factor for cataract and glaucoma development. Key points • Cataract, ocular hypertension, and glaucoma are the most common iatrogenic complications. • Systemic steroids can be safely used in uveitis patients.
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|