2020–2021 BCSC Basic and Clinical Science Course™
9 Uveitis and Ocular Inflammation
Chapter 14: Complications of Uveitis
Close monitoring with immediate attention to any postoperative increase in inflammation or complications is imperative. Visual compromise following phacoemulsification with posterior chamber lens implantation in patients with uveitis is usually attributed to posterior segment abnormalities, most commonly UME. Postoperative UME rates may be reduced through the use of perioperative corticosteroids and with delay of surgery until the uveitis has been controlled for at least 3 months. The postoperative course may also be complicated by the recurrence or exacerbation of uveitis. The incidence of posterior capsule opacification is higher in uveitic than nonuveitic eyes, leading to earlier use of Nd:YAG laser capsulotomy. Furthermore, Nd:YAG capsulotomy may exacerbate uveitis, suggesting that some uveitis patients undergoing capsulotomy may benefit from more careful monitoring after the procedure. In some uveitic conditions, such as pars planitis, inflammatory debris may accumulate, and membranes may form on the surface of the IOL. Strict control of inflammation remains paramount for reducing the chance of these deposits. Long-term administration of topical corticosteroids may be necessary. Despite aggressive use of IMT, inflammatory cocooning of the IOL–lens capsule complex and uncontrolled inflammation may necessitate IOL explantation in 5%–10% of patients. Frequent follow-up, a high index of suspicion, and aggressive IMT can optimize short- and long-term visual results.
AAO PPP Committee, Secretary for Quality of Care, Hoskins Center for Quality Eye Care. Preferred Practice Pattern® Clinical Questions. Preoperative Control of Uveitis. San Francisco: American Academy of Ophthalmology; 2013. Available at www.aao.org/ppp.
Adán A, Gris O, Pelegrin L, Torras J, Corretger X. Explantation of intraocular lenses in children with juvenile idiopathic arthritis–associated uveitis. J Cataract Refract Surg. 2009;35(3):603–605.
Bélair ML, Kim SJ, Thorne JE, et al. Incidence of cystoid macular edema after cataract surgery in patients with and without uveitis using optical coherence tomography. Am J Ophthalmol. 2009;148(1):128–135.
Jancevski M, Foster CS. Cataracts and uveitis. Curr Opin Ophthalmol. 2010;21(1):10–14.
Nemet AY, Raz J, Sachs D, et al. Primary intraocular lens implantation in pediatric uveitis: a comparison of 2 populations. Arch Ophthalmol. 2007;125(3):354–360.
Quiñones K, Cervantes-Castañeda RA, Hynes AY, Daoud YJ, Foster CS. Outcomes of cataract surgery in children with chronic uveitis. J Cataract Refract Surg. 2009;35(4):725–731.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.