Cataract Associated With Uveitis
Lens changes may occur as a result of chronic uveitis or associated corticosteroid therapy. Typically, a PSC develops, but anterior lens opacification may also occur. The formation of posterior synechiae is common in uveitis, often with thickening of the anterior lens capsule, which may have an associated fibrous pupillary membrane. Lens changes in cataract secondary to uveitis may progress to a mature cataract. Calcium deposits may be observed on the anterior capsule or within the lens substance.
Cortical cataract formation occurs in up to 70% of cases of Fuchs heterochromic uveitis (Fig 5-23). Posterior synechiae are uncommon in this syndrome; formation of pupillary membranes is unlikely; and long-term corticosteroid therapy is not indicated. Cataract extraction in patients with Fuchs heterochromic uveitis generally has a favorable prognosis. Intraoperative anterior chamber hemorrhage at the time of cataract surgery has been reported in approximately 8%–25% of cases.
Figure 5-23 Clinical photographs from a patient with Fuchs heterochromic uveitis. A, The affected eye is lighter. B, Normal right eye. C, Cataract formation in the affected left eye.
(Courtesy of Karla J. Johns, MD.)
Jones NP. Cataract surgery in Fuchs’ heterochromic uveitis: past, present and future. J Cataract Refract Surg. 1996;22(2):261–268.
Keles S, Ondas O, Ates O, et al. Phacoemulsification and core vitrectomy in Fuchs’ heterochromic uveitis. Eurasian J Med. 2017;49(2):97–101.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.