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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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Keles S, Ondas O, Ates O, Ekinci M, Kartal B, Arpali E, Yildirim K, Ceylan E, Baykal O. Phacoemulsification and Core Vitrectomy in Fuchs' Heterochromic Uveitis. Eurasian J Med 2017. [PMID: 28638250 DOI: 10.5152/eurasianjmed.2017.17026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of phacoemulsification combined with posterior capsulorhexis, core vitrectomy and ciliary sulcus intraocular lens (IOL) implantation in patients with Fuchs' heterochromic uveitis (FHU). MATERIALS AND METHODS A total of 18 eyes of 18 patients with FHU underwent cataract surgery were included in the study. 18 eyes with FHU underwent posterior capsulorhexis, core vitrectomy and poly (methyl methacrylate) (PMMA) IOL implantation in the ciliary sulcus. Subjects were chosen for this procedure based on an intraoperative vitreous haziness assessment, performed by indirect ophthalmoscopy. Patients with +2 or more vitreous haziness qualified for this procedure. RESULTS Of the 83 eyes with FHU that underwent cataract surgery, 18 eyes (21.6%) of 18 patients were employed in the study. There were 11 (61.1%) men and 7 (38.9%) women in the study; ages ranged from 23 to 47, with a mean of 32.06 years. Follow-up ranged from 8 months to 49 months. There were no intraoperative complications except for peripheral iris bleeding in 7 eyes. There was no severe intraocular inflammation in any patient postoperatively. All patients had 0.05 or better logMAR visual acuity after corneal suture removal. Glaucoma developed in 2 patients. For the short term period, the main vision threatening problem was suture-induced astigmatism. CONCLUSION Cataract surgery combined with posterior capsulorhexis, core vitrectomy and IOL implantation in the ciliary sulcus is safe and leads to good visual outcome due to the removal of the hazy vitreous in patients with FHU.
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Affiliation(s)
- Sadullah Keles
- Department of Ophthalmology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Osman Ondas
- Department of Ophthalmology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Orhan Ates
- Department of Ophthalmology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Metin Ekinci
- Department of Ophthalmology, Medical Park Hospital, Kocaeli, Turkey
| | - Baki Kartal
- Department of Ophthalmology, Buhara Hospital, Erzurum, Turkey
| | - Eren Arpali
- Department of Ophthalmology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Kenan Yildirim
- Department of Ophthalmology, Igdır State Hospital, Iğdır, Turkey
| | - Erdinc Ceylan
- Department of Ophthalmology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Orhan Baykal
- Department of Ophthalmology, Atatürk University School of Medicine, Erzurum, Turkey
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Rashid W, Lone I, Mir AM, Rashid A, Latif M. Fuchs Heterochromic Iridocylitis: Clinical Characteristics and Outcome of Cataract Extraction with Intra Ocular Lens Implantation in a Kashmiri Population- A Hospital Based Study. J Clin Diagn Res 2017; 10:NC13-NC16. [PMID: 28208900 DOI: 10.7860/jcdr/2016/21244.9111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/19/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Fuchs Heterochromic Iridocylitis (FHI) is a rare form of uveitis which is frequently complicated by cataract and glaucoma, but it does not show typical features of uveitis like pain, redness and posterior synechia. AIM To study the clinical characteristics and outcome of cataract extraction with Intra Ocular Lens (IOL) implantation in patients with FHI. MATERIALS AND METHODS The present prospective study was carried out in the Postgraduate Department of Ophthalmology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Bemina from March 2012 to January 2015. The study included 33 eyes of 32 patients of FHI who underwent thorough clinical examination and cataract surgery with IOL implantation and were evaluated based on their visual outcome and intra and post-operative complications. Post-operative follow-up was done on 1st day, one week, one month, two month, six month and at twelve months. RESULTS Mean age of our study group was 33.9 years (Range 18 to 65 years). No male or female preponderance was seen. There was bilateral involvement of eyes in only one case. Cataract and stellate keratic precipitates were present in all cases whereas, heterochromia was present in only six eyes (18.75%). Best Corrected Visual Acuity (BCVA) showed a significant improvement following cataract surgery (p<0.001). Post-operatively, 26 eyes (78.78%) showed an improvement of four lines or more (BCVA of > 6/12). Most common causes of decreased vision post-operatively were vitreous opacities in nine eyes (27.27%) followed by glaucoma in eight eyes (24.24%) and posterior capsular opacification in six eyes (18.18%). CONCLUSION Cataract extraction with IOL lens implantation in FHI is a safe procedure associated with good visual prognosis and few complications. However, glaucoma is one of the main concerns and should be closely monitored both pre and post-operatively.
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Affiliation(s)
- Wasim Rashid
- Senior Resident, Department of Ophthalmology, SKIMS, Medical College , Bemina, Srinagar, India
| | - Imtiyaz Lone
- Assistant Professor, Department of Opthalmology, SKIMS, Medical College , Bemina, Srinagar, India
| | - Adil Majid Mir
- Fellow Paediatric Ophthalmology, LVPEI , Hyderabad, India
| | - Aamir Rashid
- Post Doctoral Fellow Paediatric Cardiology, SCTIMST , Trivenderum, Kerela, India
| | - Mehreen Latif
- Tutor Demonstrator, Department of Forensic Medicine, SKIMS, Medical College , Bemina, Srinagar, India
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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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Javadi MA, Jafarinasab MR, Araghi AAS, Mohammadpour M, Yazdani S. Outcomes of phacoemulsification and in-the-bag intraocular lens implantation in Fuchs' heterochromic iridocyclitis. J Cataract Refract Surg 2005; 31:997-1001. [PMID: 15975468 DOI: 10.1016/j.jcrs.2004.08.050] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2004] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the visual outcomes and complications of phacoemulsification (PE) and posterior chamber intraocular lens implantation, (PC IOL) in patients with Fuchs heterochromic iridocyclitis (FHIC). SETTING Private clinic and an academic hospital. METHODS In this noncomparative interventional case series, existing data for 41 eyes of 40 consecutive patients clinically diagnosed with FHIC and cataract were studied retrospectively. Scleral tunnel PE and in-the-bag IOL implantation were performed in all cases. Preoperative and postoperative visual acuities and intraoperative and postoperative complications were evaluated. RESULTS Twenty-four male and 16 female patients aged 12 years to 70 (SD) (mean 35 +/- 12 years) were operated on and followed for 17.8 +/- 8.7 months. Preoperatively, best corrected visual acuity (BCVA) was less than 20/40 in all patients, which improved to 20/40 or better after surgery. Twenty-two eyes (53.6%) achieved BCVA of 20/20. The major cause of postoperative visual acuity less than 20/20 was vitreous haze. There were no major intraoperative complications. Postoperatively, mild anterior chamber fibrin reaction occurred in 4 patients (9.7%), IOL deposits occurred in 11 eyes (26.8%), and decentration was observed in 1 eye. During follow-up, 6 eyes (14.6%) developed posterior capsule opacification requiring a neodymium:YAG (Nd:YAG) laser capsulotomy. There was 1 case of clinical cystoid macular edema that resolved with medication. There were no cases of posterior synechias, postoperative glaucoma, or retinal detachment. CONCLUSION Phacoemulsification with PC IOL implantation is a safe procedure with good visual outcomes in patients with FHIC and cataract.
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Affiliation(s)
- Mohammad-Ali Javadi
- Ophthalmology Department and Ophthalmic Research Center, Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, 16666 Tehran, Iran.
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Durrani OM, Meads CA, Murray PI. Uveitis: A Potentially Blinding Disease. Ophthalmologica 2004; 218:223-36. [PMID: 15258410 DOI: 10.1159/000078612] [Citation(s) in RCA: 197] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Accepted: 01/02/2004] [Indexed: 11/19/2022]
Abstract
Uveitis (intraocular inflammation) is a potentially blinding group of, probably autoimmune, conditions predominantly occurring in the working age group. Although the aetiology is unknown in most cases, many patients have an associated underlying systemic disease. Central vision loss, in the form of cystoid macular oedema, is the commonest type of visual impairment. Although historical incidence and prevalence data exists, little is known about the degree of vision loss experienced, and the social and financial consequences of having temporary or permanent visual impairment in this age group. The literature is also full of uncontrolled studies and case reports of different modalities of drug therapy for uveitis. This article attempts to raise the awareness of uveitis as an important sight-threatening group of conditions by highlighting the paucity of evidence-based data on epidemiological, quality of life, socioeconomic, and therapeutic aspects.
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Affiliation(s)
- O M Durrani
- Academic Unit of Ophthalmology, The University of Birmingham, Birmingham, UK
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Abstract
Cataract surgery in a patient with uveitis is more complex than senile cataract extraction, because it involves multiple considerations related to the cause of uveitis, prospects of visual rehabilitation, appropriate surgical timing and technique, and the type and material of the intraocular lens used. Establishing the diagnosis, thorough eye examination, careful patient selection and meticulous control of perioperative inflammation are key elements to a successful visual outcome. Our aims in this article are to review the literature on this subject over the past year and highlight the behavior of intraocular lenses of various biomaterials in the uveitic eye. In addition, we also reemphasize the idea of a model of zero tolerance to intraocular inflammation to minimize the incidence of irreversible damage to ocular structures essential to good vision.
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Affiliation(s)
- Charles Stephen Foster
- Ocular Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, 02114, USA.
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Ram J, Kaushik S, Brar GS, Gupta A, Gupta A. Phacoemulsification in patients with Fuchs' heterochromic uveitis. J Cataract Refract Surg 2002; 28:1372-8. [PMID: 12160806 DOI: 10.1016/s0886-3350(02)01298-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the results of phacoemulsification with capsular bag fixation of a poly(methyl methacrylate) (PMMA), acrylic, or silicone intraocular lens (IOL) in patients with complicated cataract resulting from Fuchs' heterochromic uveitis (FHU). SETTING Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS This study evaluated 20 eyes of 19 patients with FHU and cataract who had uneventful phacoemulsification with endocapsular implantation of an IOL and completed a 1-year follow-up. RESULTS Preoperatively, loss of the iris collarette and fine keratic precipitates were seen in all 20 eyes, iris heterochromia in 16, iris atrophy in 12, and iris nodules in 2. Fourteen eyes had mild or negligible preoperative anterior chamber inflammation. No eye had increased intraocular pressure. An acrylic IOL was implanted in 10 eyes, a silicone IOL in 4, and a PMMA IOL in 6. There were no significant differences in outcomes among the 3 IOL groups. Three patients had intraoperative hyphema that resolved spontaneously. Postoperatively, 16 eyes had mild anterior chamber reaction. Four patients had significant anterior chamber inflammation necessitating the use of frequent topical steroids. No case had secondary glaucoma or posterior synechias. The best corrected visual acuity was 6/5 in 6 eyes, 6/6 in 11, and 6/9 in 3. CONCLUSIONS Uneventful phacoemulsification with endocapsular IOL implantation visually rehabilitated patients with FHU. All 3 IOLs yielded similar results except for increased early postoperative inflammation and late dense anterior capsule opacification in the silicone group. Further studies comparing the outcome of different IOL materials are required to determine their effectiveness in patients with FHU.
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Affiliation(s)
- Jagat Ram
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
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Affiliation(s)
- C Muccioli
- Uveitis Section, Federal University of São Paulo, Brazil
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Waters FM, Goodall K, Jones NP, McLeod D. Vitrectomy for vitreous opacification in Fuchs' heterochromic uveitis. Eye (Lond) 2000; 14 ( Pt 2):216-8. [PMID: 10845020 DOI: 10.1038/eye.2000.57] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess the role of pars plana vitrectomy (PPV) for symptomatic vitreous opacification in a series of patients with Fuchs' heterochromic uveitis (FHU). METHODS A retrospective review was undertaken of 13 patients with FHU who underwent vitrectomy for vitreous opacification between April 1989 and December 1998. RESULTS An improvement in visual symptoms was recorded in all patients, 9 of 13 (69%) demonstrating at least a 2 line increase in Snellen visual acuity. All but one patient attained 6/9 or better visual acuity post-operatively. Surgery was uneventful and did not appear to exacerbate any existing intraocular inflammation. CONCLUSION From this series we conclude that PPV has an important role in the management of patients with FHU who present with symptomatic vitreous opacification.
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