Early and Late Complications after Cataract Surgery in Patients with Uveitis

Evaluation of postoperative outcomes after cataract surgery in patients with Juvenile Idiopathic Arthritis-Associated Uveitis

PurposeTo evaluate the postoperative outcomes of cataract surgery and intraocular lens (IOL) implantation on visual outcomes and complications in pediatric patients with Juvenile Idiopathic Arthritis-Associated Uveitis.MethodsThis study included 25 patients (30 eyes) with uveitis and cataracts who underwent cataract surgery. The study was conducted as a retrospective study. Patients were divided into two groups based on their preoperative treatment: those who received immunomodulatory therapy (IMT) along with systemic corticosteroids and those who received IMT in combination with a biologic therapy. Best corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), macular volume (MV), and postoperative complications were assessed at various time points up to 12 months. All surgeries were performed by a single surgeon.ResultsSignificant improvement in BCVA were observed postoperatively in both study groups, with approximately 80% of eyes showing improvement. Mean BCVA improved from 0.89 ± 0.63 to 0.37 ± 0.33 in group 1and from 0.82 ± 0.68 to 0.35 ± 0.31 in group 2 after 12 months. Postoperatively, there was a decrease in mean IOP, with no significant variance observed between the two groups. Complications were observed in 73% of cases, including posterior capsular opacification (PCO), secondary glaucoma, and macular edema (ME), but did not significantly differ between groups.ConclusionCataract surgery in children with uveitis associated with JIA presents significant challenges due to the risk of postoperative complications, even with adequate preoperative and postoperative care. The similar improvement in BCVA observed in both groups suggests that different systemic therapies were sufficient for satisfactory control of inflammation before and after surgery.

Fluocinolone acetonide 0.18-mg implant for treatment of recurrent inflammation due to non-infectious uveitis: a case series of 15 patients

INTRODUCTION

Uncontrolled non-infectious uveitis affecting the posterior segment (NIU-PS) can lead to vision loss due to repeated bouts of inflammation and consequent tissue damage. Patients with chronic NIU-PS who experience recurrent uveitis after being treated with systemic and short-acting local corticosteroids may benefit from the sustained-release 0.18-mg fluocinolone acetonide implant (FAi).

METHODS

In this case series, 18 eyes with chronic, recurrent NIU-PS and cystoid macular edema (CME) treated with the 0.18-mg FAi were analyzed retrospectively. Data on patient demographics, clinical history, previous and concomitant treatments for uveitis recurrence, time to and number of uveitis recurrences, intraocular pressure (IOP), central subfield thickness (CST), and visual acuity (VA) were collected and summarized.

RESULTS

A majority of patients (14/15 [93%]) had a history of ocular surgery, largely cataract extraction, and all developed chronic and recurrent NIU-PS and CME. At baseline, patients had a mean age of 72 years (range: 46 to 93), were 53% male, and had a mean duration of NIU-PS of 3 years (range: 1 to 19). Patients were followed for an average of 16.5 months (range: 2 to 42.5 months) post FAi. Eleven of the 18 eyes (61%) had ≥ 5 recurrences of uveitis since diagnosis, with an average time to recurrence of approximately 12 weeks (range: 1 to 27). All eyes treated with the 0.18-mg FAi showed reduced NIU-PS recurrence and visual and anatomical improvement, as measured by VA and CST, respectively. Two eyes had an IOP elevation that was managed with topical therapy, and one eye was treated with topical prednisolone for additional inflammation management. Two eyes required adjunct therapy with short-acting intravitreal corticosteroids at 7 and 16 weeks for NIU-PS recurrence after 0.18-mg FAi insertion.

CONCLUSION

After receiving the 0.18-mg FAi, eyes with uncontrolled NIU-PS had sustained resolution of CME and inflammation with limited need for supplementary steroid drops or injections and minimal steroid class-specific adverse effects; none required incisional IOP-lowering surgery.

Exploring anterion capsular contraction syndrome in cataract surgery: insights into pathogenesis, clinical course, influencing factors, and intervention approaches

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.