Cataract Surgery Linked to Greater Challenges in Eyes with Uveitis

Eyes with concurrent uveitis in a Swedish cohort had worse BCVA prior to and following cataract surgery, although visual improvement was greater compared to control eyes.

The presence of uveitis was associated with higher risks of complications during cataract surgery, as well as in the post-operative period, according to new research from Sweden.

The findings suggest an association between uveitis and poorer best-corrected visual acuity (BCVA) preoperatively as well as postoperatively, but visual improvement was found to be slightly better in uveitic eyes.

“Although preexisting pathology might partly explain the inferior visual outcome in patients with uveitis, in addition, surgery in uveitis eyes was associated with more difficulties and posterior capsule rupture/zonulolysis, in turn possibly contributing to worse visual results,” wrote corresponding author Sara Pålsson, MD, Institute of Neuroscience and Physilogy, Department of Clinical Neuroscience/Ophthalmology, Sahlgrenska Academy at University of Gothenburg. “Still, uveitis eyes displayed greater visual improvement than did non-uveitis eyes, possibly reflecting denser cataract pre-operatively, but also showing that uveitis eyes do well with surgery.”

Specific considerations are required when managing cataract in the setting of uveitis, but there is no consensus opinion on optimal treatments and surgical approaches. Led by Pålsson and colleagues, the study aimed to provide additional knowledge of current surgical and medical treatments and visual outcomes in eyes with cataract and uveitis.

In order to analyze the differences between patients with and without uveitis, data were collected from the Swedish National Cataract Registry between January 2018 and December 2019. The cohort was divided into four groups for the analysis: core uveitis, core no uveitis, outcome uveitis, and outcome no uveitis.

The core register contained information on 719 patients with uveitis and 256,360 patients without uveitis during the study period. Patients with uveitis were noted as significantly younger at the time of surgery, with a mean age of 66.0 years compared with a mean age of 74.3 years for controls (P <.001). The outcome register included 52 patients with uveitis and 14,489 patients without uveitis.

Most eyes in both the core uveitis and core control groups received a hydrophobic acrylic intraocular len (IOL) in 693 eyes (96.4%) in the uveitis group and 253,164 (98.8%) in the control group (P <.001). However, hydrophilic acrylic IOLs were more frequent in eyes with uveitis (n = 26; 3.6%) than in control eyes (n = 2989; 1.2%; P <.001).

The findings suggest surgery was associated with significantly more difficulties in the setting of uveitis (n = 194; 27.0%) than in controls (n = 18,200; 7.1%; P <.001). As previously indicated, posterior capsule rupture or zonulolysis were more common in patients with uveitis, occurring in 9 eyes with uveitis (1.3%) and in 1464 eyes without uveitis (0.6%; P = .02).

Both groups of eyes were equally likely to receive any postoperative treatment with either steroids or non-steroidal anti-inflammatory drugs (NSAIDs), according to investigators.

Eyes included in the outcome cohort had a mean preoperating BCVA of 0.54 ± 0.52 logMAR for those with uveitis and 0.38 ± 0.32 logMAR for those without uveitis (P <.001). Postoperatively, visual acuity was shown to improve in both eyes with (n = 52) and without (n = 14,489) uveitis, with mean BCVAs of 0.16 ± 0.38 and 0.08 ± 0.20 logMAR, respectively (P = .008).

The data show the preoperative to postoperative change in BCVA was greater in patients with uveitis at a mean of –0.38 ± 0.38 versus –0.30 ± 0.30 (P = .04).

“Our findings also indicate there is a great diversity in how uveitic patients are treated when undergoing cataract surgery and national guidelines would be desirable,” Pålsson added. “Multicenter randomized trials are needed to further evaluate the impact of IOL material and to assess the optimal anti-inflammatory treatment in patients with uveitis undergoing cataract surgery.”

The study, “Cataract surgery in patients with uveitis: Data from the Swedish National Cataract Register,” was published in Acta Ophthalmologica.