Integrated Approach To Panuveitis Management: Combined Complicated Cataract And Pars Plana Vitrectomy Procedure

To highlight how panuveitis caused by ocular trauma with complicated cataract sequelae can be safely and methodically managed to provide patients with the best chances of vision recovery.

Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy

The patient, aged 39, presented with a history of ocular trauma and subsequent panuveitis. Prior to the clinic visit, he was undergoing therapy with Cloramfenicole, Betametasone, Tropicamide drops, and Prednisone orally. In the examination of the right eye, the intraocular pressure was 7 mmHg. Visual acuity was assessed as hand motion. A previous conjunctival wound at 3 o'clock was noted, with a clear cornea and normal anterior chamber depth. Mild inflammation was indicated by a Tyndall effect of 1+. Irido-lenticular synechiae spanning 360 degrees and both anterior and posterior cortical cataracts were observed. However, the posterior segment was not explorable. The left eye showed no pathological findings.

Phacoemulsification with intraocular lens implantation and pars plana vitrectomy was recommended for the right eye, with consideration of the functional prognosis. Cataract surgery commenced, addressing irido-lenticular synechiae and employing iris hooks. Following cataract removal, the posterior vitreous appeared entirely opaque. Intraocular lens implantation was performed, followed by closure of paracenteses and corneal suturing with 10.0 nylon. Trocars (23 G) were inserted, and anterior and mid-vitreous vitrectomy executed to visualize the ocular fundus. A complete vitrectomy, including peripheral vitrectomy shave, was carried out. Posterior capsulorexis was performed and iris hooks were removed. 

Fortunately, the posterior pole remained intact, fostering hope for functional recovery of the right eye. While the prognosis remains reserved, a combined cataract and pars plana vitrectomy procedure in a single surgery can afford us the best outcomes for the patient and offer the opportunity to plan future steps. Furthermore, it leads us to reconsider that a delayed vitrectomy in panuveitis may not always result in a complete condemnation for the outcome of a delayed intervention.