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First Author: R.Rebane ESTONIA
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To describe a case of a patient with chronic anterior granulomatous uveitis and her pre- and postoperative corticosteroid therapy before and after cataract surgery following her systemic treatment with mitoxantrone.
Current opinions on corticosteroid regimens in cases of chronic anterior uveitis in different centers were reviewed though literature to fit this case.
A 54-year old woman with primary progressive multiple sclerosis was 2 years topically treated for bilateral anterior uveitis. Her right-sided cataract was precipitated by treatment with intravenous chemotherapy with mitoxantrone and topical corticosteroids. Due to nuclear and posterior subcapsular cataract, the patients BCVA decreased from 0,5 to 0,1 in 2 months time and therefore she needed help in everyday living. BCVA in the left eye was 0,7 with visual field constriction. 1 month after her second chemotherapy with mitoxantrone due to multiple sclerosis phacoemulsification was planned. Before the operation, the patient had mild anterior uveitis with keratic precipitates 1+, flare 1+ and no synechiae. Preoperative topical regimen was dexamethasone twice a day and due to secondary glaucoma timolol/dorzolamide also twice a day. 1 mg/kg oral prednisolone 3 days before surgery was chosen as prophylaxis and the surgery was uneventful. In the postoperative setting no complications occurred and the BCVA increased to 0.9.
Oral steroid therapy in eyes with uveitis undergoing phacoemulsification is important and crucial to visual endpoint, because cataract surgery can exacerbate uveitis. Corticosteroid use after chemotherapy is not contraindicated. This patient had no change in the inflammative state of the eye after surgery.
1 mg/kg prednisolone 3 days before the operation and taper in 2 weeks is a safe option in selected cases of chronic anterior uveitis. Phacoemulsification with primary IOL implantation is the preferred method.