Sonia Mehta1, Melody M Linton2, John H Kempen3. 1. Vitreoretinal Diseases & Surgery Service, Wills Eye Hospital, Department of Ophthalmology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. 2. Ocular Inflammation Service, Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Ocular Inflammation Service, Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: john.kempen@uphs.upenn.edu.
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.
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.
Authors: Asieh Golozar; Yujiang Chen; Kristina Lindsley; Benjamin Rouse; David C Musch; Flora Lum; Barbara S Hawkins; Tianjing Li Journal: JAMA Ophthalmol Date: 2018-05-01 Impact factor: 7.389
Authors: H Nida Sen; Francis M Abreu; Thomas A Louis; Elizabeth A Sugar; Michael M Altaweel; Susan G Elner; Janet T Holbrook; Douglas A Jabs; Rosa Y Kim; John H Kempen Journal: Ophthalmology Date: 2015-10-20 Impact factor: 12.079
Authors: Maxwell Pistilli; Marshall M Joffe; Sapna S Gangaputra; Siddharth S Pujari; Douglas A Jabs; Grace A Levy-Clarke; Robert B Nussenblatt; James T Rosenbaum; H Nida Sen; Eric B Suhler; Jennifer E Thorne; Nirali P Bhatt; C Stephen Foster; Hosne Begum; Tonetta D Fitzgerald; Kurt A Dreger; Michael M Altaweel; Janet T Holbrook; John H Kempen Journal: Ocul Immunol Inflamm Date: 2019-12-10 Impact factor: 3.728