Surgery Of Cataract Complicated By Chronic Uveitis: Long-Term Results

Published 2024 - 42nd Congress of the ESCRS

Reference: PO532 | Type: Free paper | DOI: 10.82333/9sey-m856

Authors: Olga Safonova* ¹ , Oleg Shilovskikh ¹

¹IRTC Eye Microsurgery Center,Ekaterinburg,Russian Federation

Purpose

To estimate long-term results after surgery of cataract complicated by chronic uveitis.

Setting

160 eyes of 109 patients have been operated. Follow-up period was from 2 to 15 years (mean, 5 years). All the patients had chronic or recurrent uveitis, 26.3% at the background of rheumatoid arthritis, 16.3% of ankylosingspondylitis. 11.3% had HLA B27- positive status, in 28.1% etiology was unknown, in the rest of cases other etiologic factors took place. In most cases cataract was associated with posterior synechiae, exudative pupillary membrane, vitreous opacities, cystic macular edema.

Methods

Operation included separation of synechiae, removal of pupillary membrane, cataract phacoemulsification, posterior capsulorhexis, anterior vitrectomy. After that a 3-piece hydrophobic acrylic IOL was implanted into the capsular bag in a certain sequence. Optic part of the IOL was placed behind the posterior capsulorhexis. In the eyes with existing macular edema a dose of 4 mg previously centrifuged triamcinolone acetonide was injected in suprachoroidal space.

In the early and long-term post-op period BCVA, IOP were estimated. Optical coherence tomography of the anterior segment was used to define indicators of effective IOL position (tilt, decentration, distance from retina posterior surface to IOL anterior surface).

Results

BCVA has increased in 97.5% of cases; it made 0.2 to 0.5 in 64% of cases and 0.6 to 1.0 in 21% of cases. IOP was 14.2 ± 5.1 mm Hg. Main factors negatively impacting visual acuity were epiretinal membrane, maculopathy, optic atrophy, band keratopathy. In 2 cases retinal detachment requiring vitrectomy has occurred. Two cases with pre-existing ciliary body changes ended in subatrophy. No cases of anterior synechiae forming, secluded pupil, optic capture were marked. Mean distance from posterior iris surface to anterior IOL surface made 0.7 mm which is by 0.37 mm more compared to standard intracapsular IOL fixation. Mean indicators of tilt (5.9 degrees) and decentration (0.34 mm) were comparable to control group.

Conclusions

Long-term results of the developed technology for the treatment of cataract complicated by chronic uveitis demonstrate normalization of anterior segment structures anatomy, stable effective IOL position, increase of optic media transparency, and improvement of clinical and functional indicators.