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Prolonged hypotony after cataract surgery

Poster Details

First Author: C.Montón Giménez SPAIN

Co Author(s):    E. Conesa Hernandez   E. Mata Diaz   Ã. Sanchez-Ventosa   B. Jimenez Rolando   C. de Pablo Martin  

Abstract Details

Purpose:

To describe the risk factors and the best strategy for preventing the hypotonia after cataract surgery in a patient with non-infectious uveitis. Patients with uveitis develop cataract due to both uveitis and the treatment with corticosteroids. These cataracts suffer a higher rate of complications both during the surgery and after due to a high probability of postoperative inflammatory response. Although the risk of hypotonia is low among eyes with non-infectious uveitis, it is more frequent in cases with anterior segment inflammation. Phacoemulsification produces lower risk of hypotonia than alternative cataract surgery.

Setting:

Department of Ophthalmology .Hospital de Cruz Roja San Jose y Santa Adela.Madrid. Spain

Methods:

We report the case of a fifty-six-year-old female with posterior subcapsular cataract in her left eye. Ophthalmological history: pars planitis with recurrent anterior uveitis and posterior synechiae, myopia magna, simple chronic glaucoma. Multidisciplinary treatment (9 years of evolution, ophthalmology and rheumatology): methotrexate, anti-glaucoma eye drops, topical steroid. Phacoemulsification was performed by an experienced surgeon with retrobulbar anesthesia. Posterior synechiae hinders pupillary dilation and access to the cataract. They were released with the aid of a blunt spatula and viscoelastic. Iris hooks were also used. There were no complications during surgery.

Results:

Surgery was indicated after 3 months without inflammation. Corticosteroids were prescribed regularly for an extended period of time before the surgery, and a high dose the day of the surgery. The patient presented postoperative inflammation and hypotonia (0mmHg). She was treated with high doses of oral and topical corticosteroids. The patient showed improvements after a month, recovering the normal intraocular pressure and visual acuity.

Conclusions:

Patients with uveitis, in particular anterior uveitis, present a high number of complications after cataract surgery. Some steps are important in order to reduce the risks. Preoperative factors: (1) the surgery should be indicated after a period of inactivity, (2) preoperative steroids help to control postoperative inflammation. Intraoperative factors: (3) adequate exposure of the pupillary area using iris hooks will reduce risks during phacoemulsification. In our experience, these steps help to achieve better visual results. FINANCIAL DISCLOUSRE: NONE

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