Visual Outcomes Following Cataract Surgery In Eyes With Uveitis

Cataract is a common complication of uveitis, driven by chronic inflammation and corticosteroid therapy. Surgery aims to restore visual function and facilitate assessment of posterior segment disease. However, perioperative inflammation, uveitic structural sequelae, and pre-existing macular or optic nerve pathology can limit achievable visual outcomes and increase complication risk. This systematic review evaluates visual outcomes following cataract surgery in uveitic eyes, the factors that determine them, and areas where evidence remains limited or conflicting.

Systematic review conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

A systematic literature search of CENTRAL, MEDLINE, PubMed, EMBASE, and ClinicalTrials.gov was conducted on 01 April 2025. Two independent reviewers performed title, abstract, and full-text screening. Eligible studies included adult patients with uveitis undergoing cataract surgery, reported outcomes for at least 100 eyes, and included visual acuity as an outcome measure. Randomised controlled trials, prospective cohort studies, and retrospective cohort studies were included. Data were synthesised qualitatively.

26 papers were included, comprising 8,902 eyes (87.7% phacoemulsification). Pre- and postoperative visual acuity (VA) were worse in uveitic compared to non-uveitic eyes (n=2,822). Preoperative VA in uveitic eyes was poor (0.6–1.7 logMAR, n=5,365), but postoperative outcomes were good (0.15–0.4 logMAR, n=3,629; 30–90% ≤0.30 logMAR, n=5,293).

Poor baseline VA predicted poorer outcomes (n=2,506), principally due to macular and optic nerve disease (n=557). Anterior uveitis was associated with the best visual outcomes and the lowest rates of postoperative recurrence (n=2,681 and n=347, respectively). Behçet’s disease was associated with the least visual gain (n=462), likely reflecting higher relapse rates rather than worse baseline VA (n=236).

Cataract surgery in uveitis reliably delivers meaningful visual improvement, frequently to functional levels. Although poor baseline VA is associated with worse outcomes, macular and optic nerve comorbidity represent the principal constraints on visual recovery. Where poor baseline VA reflects dense cataract rather than structural disease, meaningful improvement remains achievable provided inflammation is appropriately managed perioperatively.