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Session Title: Complex Cases and Surgery
Session Date/Time: Monday 07/10/2013 | 14:30-16:00
Paper Time: 14:51
Venue: Forum (Ground Floor)
First Author: : V.Cerovic CROATIA
Co Author(s): : N. Gabri? A. Barii? M. Ratkovi?
Cataract develops in patients with uveitis because of the uveitis itself and also because of the steroids which is cornerstone of treating uveitis. Cataract developing in an eye with a history of chronic or recurrent uveitis has historically been called cataracta complicata, and, indeed, the uveitic cataract is complicated cataract. It is complicated both from the standpoint of technical aspects of the surgery itself (limited access secondary to posterior synechiae, pupillary membrane, and pupillary sphincter sclerosis, iris delicacy and vascular abnormalities, and pre-existing glaucoma), and also because of the high likelihood of an exuberant postoperative inflammatory response which can ruin the desired surgical outcome.
We will show you few video presentations of cataract surgery in uveitic eyes. All patients were operated by one surgeon in Svjetlost" Eye Hospital in last two years.
The most important steps prior to surgery is control of inflammation, timing the surgery adequately and assessing the degree of cataract as well as prognostication after the surgery. For most forms of uveitis, three-month inflammation free period is considered adequate for planning cataract surgery. Many of these eyes with prior anterior uveitis have posterior synechiae with the iris adherent to the anterior lens capsule. The synechiae as well as any pupillary membrane can limit pupil dilatation and limit access to the cataract. The membrane and synechiae can be dissected with forceps, a blunt spatula or even with viscoelastic solution. The pupil can than be expanded mechanically and, if needed, held in the position with iris hooks or other expansion devices.
Improvement in microsurgical techniques have also improved the results. The postoperative period following cataract surgery in uveitic eyes can be potentionaly stormy. Exacerbation of inflammation, membrane formation, elevation of intraocular pressure, formation of synechiae, greater incidence of the posterior capsular opacification and macular changes in the form of cystoid macular edema ar not uncommon. All patients need to be on frequent topical steroids and non-steroidal anti-inflammatory agents in addition to oral therapy which is started preoperatively in selected cases. In addition, topical mydriatics are added to keep the pupil mobile and prevent synachiae formations.
It is possible to achieve successful visual outcomes following cataract surgery in uveitis with the modern day cataract surgery. The predictability has improved mainly because of a higher level of understanding of the uveitic disease among clinicians. Preoprative factors include proper patient selection and counseling and preoprative control of inflammation.
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