Uveitic Cataracts – How Long Should We Wait For Quiescence Before Surgery?

Cataract surgery in uveitic eyes poses many challenges. In addition to intra-operative small pupil and zonular weakness, these eyes are predisposed to post-operative inflammation and cystoid macular oedema. Hence, disease quiescence and perioperative prophylaxis are typically advocated before surgery. However, a visually-significant cataract may impair disease monitoring, necessitating earlier surgery despite suboptimal uveitic control. In this study, we evaluated whether the duration of disease quiescence, the use of peri-operative prophylaxis, and the aetiology of underlying uveitis can predict surgical outcomes and complications following cataract surgery in uveitic eyes

This study was carried out in a uveitis clinic in a tertiary referral eye center in Singapore.

This is a retrospective review of consecutive patients with uveitic cataracts who underwent surgery from Jan 2022 to December 2024. Patient demographics, disease aetiology, pre-operative visual acuity (VA) and the use of peri-operative prophylaxis were recorded. Patients were stratified into 3 groups based on duration of disease quiescence: 1. Active uveitis or <3 months of disease quiescence (n=9); 2. 3 to 6 months (n=29); and 3. >6 months of quiescence (n=92). The main surgical outcomes evaluated included post-operative VA, control of post-operative inflammation 6 weeks after surgery, rate of cystoid macular oed.ema (CMO) and need for subsequent treatment escalation.

There were a total of 130 uveitic patients, aged 12 to 87 years (mean 63.9). Mean post-operative VA was logMAR 0.18, with no statistical difference amongst the 3 groups. All patients in group 1 had persistent post-operative inflammation despite pre-operative prophylaxis, developed significantly higher rates of CMO (p=0.0019) and had uveitis progression (p=0.015). Although the rate of post-operative inflammation was similar across different uveitis aetiologies, patients with intermediate, posterior, or panuveitis were more likely to require treatment escalation beyond topical drops post-operatively. Pre-operative prophylaxis (n=58) did not predict better control of post-operative inflammation.

A minimum of 3 months of quiescence in uveitic eyes emerged as a key determinant for controlling post-operative inflammation. While eventual post-operative visual acuity was comparable across groups, patients with active uveitis or <3 months quiescence experienced higher rates of inflammation and CMO. Peri-operative prophylaxis did not yield better outcomes, suggesting that stronger immunomodulatory strategies may be required for faster post-operative control.