Our Summary

Uveitis, a type of eye inflammation, is a leading cause of blindness around the world. One common issue that arises from uveitis is the development of cataracts, which are often caused by both the inflammation and the standard corticosteroid treatment. Managing these cataracts can be difficult, and sometimes additional procedures may be necessary, which can affect the results of the surgery.

Uveitis typically affects a fairly young group of people and may increase their risk of complications. Before any surgical intervention is done, it’s generally agreed that any inflammation or active disease should be under control for at least three months. The preferred method for cataract surgery is a procedure known as phacoemulsification with intraocular lens implantation, and this has been shown in some studies to improve eyesight in over 90% of patients.

After the surgery, some common complications can include swelling of the macula (the part of the eye responsible for sharp, central vision), clouding of the back of the lens capsule, a recurrence or continuation of the inflammation, glaucoma, a thin layer of fibrous tissue forming over the retina, and problems with the intraocular lens, like deposits or dislocation. Even though there can be complications, cataract surgery in uveitis patients is generally seen as a safe and successful procedure.

FAQs

  1. What is the most common cause of cataract development in patients with uveitis?
  2. What is the preferred method of cataract surgery for patients with uveitis?
  3. What are some common postoperative complications of cataract surgery in patients with uveitis?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cataract surgery is to follow all preoperative instructions carefully to ensure the best possible outcome. This may include controlling inflammation or quiescent disease for a minimum of three months before surgery, as well as any other specific guidelines provided by the doctor. By following these recommendations, the patient can help reduce the risk of complications and improve the overall success of the procedure.

Suitable For

Patients with uveitis who develop cataracts are typically recommended cataract surgery. Uveitis is a leading cause of blindness worldwide, and the development of cataracts is common in patients with this condition due to both the presence of intraocular inflammation and the use of corticosteroids as a treatment. Patients with uveitis are often relatively young and at higher risk of complications, so careful management of their cataracts is important.

Before undergoing cataract surgery, it is generally recommended that the uveitis is controlled or in a quiescent state for at least three months. Phacoemulsification with intraocular lens implantation is the preferred surgical method for these patients, with high rates of visual improvement reported in studies.

Despite the potential for complications such as macular edema, posterior capsule opacification, recurrent or persistent inflammation, glaucoma, and IOL deposits or dislocation, cataract surgery in uveitis patients is considered a safe and successful procedure. The goal of surgery is to improve visual acuity and quality of life for these patients.

Timeline

  • Before cataract surgery:
  1. The patient experiences symptoms such as blurry vision, glare, and difficulty seeing at night.
  2. The patient undergoes a comprehensive eye examination to determine the severity of the cataract.
  3. If the cataract is deemed to significantly impact the patient’s vision and quality of life, the patient is scheduled for cataract surgery.
  4. The patient may need to undergo preoperative tests such as measurements of the eye, including the length and curvature of the cornea, and the intraocular pressure.
  5. The patient may be instructed to stop taking certain medications, such as blood thinners, in the days leading up to surgery.
  • After cataract surgery:
  1. The patient experiences improved vision almost immediately after surgery.
  2. The patient may experience mild discomfort, redness, and sensitivity to light in the first few days after surgery.
  3. The patient is prescribed eye drops to prevent infection and promote healing.
  4. Follow-up appointments are scheduled to monitor the healing process and ensure that the patient’s vision is improving as expected.
  5. The patient may need to wear an eye shield at night to protect the eye while sleeping.
  6. The patient is advised to avoid strenuous activities, such as heavy lifting or bending over, in the weeks following surgery.
  7. The patient may need to undergo additional procedures, such as laser surgery to correct any remaining vision issues or complications such as posterior capsule opacification.
  8. Over time, the patient’s vision continues to improve, and they may need new glasses or contact lenses to achieve the best possible vision.

What to Ask Your Doctor

  1. What are the risks and benefits of cataract surgery for someone with uveitis?

  2. How long should my uveitis be under control before I can undergo cataract surgery?

  3. What type of cataract surgery is recommended for someone with uveitis?

  4. What are the potential complications of cataract surgery in uveitis patients?

  5. How will my uveitis be managed before, during, and after cataract surgery?

  6. What is the expected outcome of cataract surgery for someone with uveitis?

  7. How soon after cataract surgery can I resume my normal activities?

  8. Will I need any additional procedures or treatments after cataract surgery due to my uveitis?

  9. How often will I need follow-up appointments after cataract surgery?

  10. Are there any specific precautions I should take to prevent complications after cataract surgery with uveitis?

Reference

Authors: Llop SM, Papaliodis GN. Journal: Semin Ophthalmol. 2018;33(1):64-69. doi: 10.1080/08820538.2017.1353815. Epub 2017 Nov 29. PMID: 29185838