In patients with uveitis, cataract surgery is relatively safe

Investigators evaluated the rates of intraoperative and postoperative complications in uveitic eyes with cataracts and identified predictors of complications.

Study design

This was a retrospective observational cohort study looking at the outcomes of cataract surgery in 471 eyes with uveitis (371 patients) treated at a tertiary ophthalmology department in New Zealand. The most common uveitis etiologies were idiopathic uveitis and HLA-B27 disease, which were present in 25.1% and 13.6% of patients, respectively. The median time of quiescence prior to surgery was 1 year.

Outcomes

Intraoperative complications occurred in 6.8% of eyes; the most common complications were zonular weakness, iris prolapse, and anterior capsule tear. On univariate analysis, risk factors for intraoperative complications were posterior synechiae noted at pre-admission and a shallow anterior chamber (<2.5 mm), but no risk factors were identified on multivariate analysis. At 12 months following surgery, visual acuity was 20/50 or better in 79.7% of eyes, and 25.4% of eyes had ≥0.5+ anterior chamber cells. The most common complications after surgery were uveitis flare (56.5% of eyes) and cystoid macular edema (11.9% of eyes). Glaucoma surgery was required in 8.5% of eyes within 3 months of surgery.

Limitations

This was a retrospective study, and given that these surgeries occurred at a tertiary referral center there was likely a referral bias of worse cases.

Clinical significance

In patients with uveitis, complications of cataract surgery occur at relatively low rates. The most common complication was flare of uveitis. Careful monitoring and aggressive treatment of uveitis postoperatively is imperative.