Cataract surgery in patients with uveitis

Abstract

AbstractCataract surgery in patients with uveitis requires special considerations. Active inflammation, particularly anterior or intermediate uveitis, increases the risk for postoperative complications. Other problems include the development of postoperative adhesions between the iris and lens capsule postoperatively, membrane formation, IOL deposits, zonular problems, and cystoid macular edema (CME). Inflammation should be inactive or controlled as much as possible prior to elective surgery, minimum 3 months prior to surgery, as this reduces the risk of posteoperative CME. Collaboration with the physicians treating the patient's uveitis prior to cataract surgery will help to provide for appropriate prophylactic anti‐inflammatory therapy and improve postsurgical outcomes. Surgical planning should include the possible need for other procedures, such as managing pre‐existing posterior synechiae, pupillary membranes, zonular compromise, and fibrotic scarring of the pupillary margin. Current evidence supports a superior effect of hydrophobic acrylic lenses over silicone lenses, specifically for posterior synechiae outcome. Periocular or intraocular corticosteroids at the time of surgery should be considered. Posteoperatively the use of short‐acting topical mydriatic agents and greater frequency and duration of topical anti‐inflammatory treatment is recommended.