Cataract Surgery In Patients With Uveitis: A Five-Year Review Of A Single Centre Uveitis Service

Cataract surgery in uveitis patients presents unique challenges and increased risk of post-operative complications, such as cystoid macular oedema. A National survey by the International Uveitis Study Group has highlighted a lack of robust evidence to guide peri-operative management decisions for uveitis cataract surgery, with previous studies often not reflecting current practice. To address this gap, an up-to-date review of cataract surgery outcomes in uveitis patients is essential. This study evaluates the outcomes and complication rates of uveitis cataract surgery at a single centre over the past five years.

A single centre Ophthalmology department in the UK.

This retrospective cohort study analysed data from a single centre on patients with a history of active uveitis who underwent cataract surgery between January 1, 2019, and March 1, 2024. Clinical data was collected from the electronic medical record (EMR) system. Outcomes assessed included best-corrected visual acuity (BCVA) at one week, four to six weeks, and eight to sixteen weeks post-operatively. Additionally, intraoperative and postoperative complications within five months post-surgery were recorded. All patients were evaluated by a uveitis specialist preoperatively and underwent a standard preoperative workup with steroids. Postoperatively, patients were managed according to an established uveitis cataract protocol.

Seventy-seven eyes with a mean age of 55.9 years with a history of uveitis underwent cataract surgery over a five-year period. Preoperative management included either topical steroids for two weeks (46.8%) or a combination of topical steroids for two weeks and oral steroids for ten days (29.9%). Five eyes (7.1 %) with severe uveitis struggled to achieve a quiescent state pre-operatively and required a dexamethasone implant. Post-operatively, the mean best-corrected visual acuity at one, four to six, and eight to sixteen weeks was 0.347, 0.298, and 0.295 LogMAR, respectively. The most common postoperative complications were cystoid macular oedema (11.7%), elevated intraocular pressure (13%), and post-operative uveitis (13%).

The present study reveals that cataract surgery in patients with uveitis is associated with less predictable postoperative outcomes and higher complication rates. Recurrence of uveitis, cystoid macular oedema (CMO), and elevated intraocular pressure (IOP) are common complications in these patients. Previous studies, which employed less aggressive steroid regimens, have demonstrated limited visual outcomes. Therefore, adequate inflammatory control through corticosteroid treatment is crucial for improving post-operative visual acuity. The development of national protocols that provide evidence-based guidance for the pre-operative and post-operative management of uveitis cataract patients by specialists is imperative.