This retrospective cohort study evaluated outcomes in patients with quiescent uveitis after phacoemulsification and anterior chamber (AC) IOL implantation secondary to inadequate capsule support. The authors found that AC IOL implantation improved CDVA without a significant increase in long-term complications compared with eyes that underwent posterior chamber (PC) IOL placement.
Such a limited trial and relatively short follow-up time (three to five years is relatively short in the life of a uveitis patient) cannot definitively demonstrate safety, but this report does give some comfort to those of us who have tentatively decided to proceed with AC IOL implantation on rare occasions in eyes with uveitis. One point is that not all uveitides are the same; AC IOL implantation in any eye with birdshot chorioretinopathy is likely to be of less concern than in an eye with uveitis secondary to juvenile idiopathic arthritis, for example.
The message of this study seems to be that while AC IOL implantation in eyes with uveitis is not generally recommended, if proceeding with caution and awareness of the risks and limitations and the lack of really long-term data, it may be a viable alternative for some patients who cannot tolerate aphakia or contact lenses.
The authors identified through an electronic medical record search 18 patients (18 eyes) with uveitis and insufficient capsular support for a PC IOL who underwent AC IOL implantation. They were age-matched with uveitis patients who underwent conventional placement of a PC IOL. The mean follow-up was 36.1 months in the AC IOL group and 53.7 months in the PC IOL group.
The incidence of postoperative complications was not statistically different for any criterion except for more frequent posterior capsule opacification development in the PC IOL cohort. This was expected, as there was no or little posterior capsule in the eyes that received an AC IOL.
The mean preoperative CDVA was 1.49 logMAR in the AC IOL group and 0.5 logMAR in the PC IOL group. Both groups experienced a significant improvement in CDVA three years postoperatively. While the outcomes appeared similar, visual outcomes were better in the PC IOL group, with the differences statistically significant for the first year and borderline at year two.
Four eyes in the AC IOL group and two eyes in the PC IOL group had posterior uveitis, and two in the AC IOL group and three in the PC IOL group had intermediate uveitis. The authors write that an AC IOL might be expected to cause fewer problems with intermediate uveitis than with anterior or panuveitis because there would be fewer anterior segment complications.
While this report indicates good results with AC IOL placement, one must proceed with caution. The authors appropriately point out that a frequent complication was uveitis reactivation attributed to the IOL, and ultimately the IOL had to be removed in two eyes in the AC IOL group and in one eye in the PC IOL group due to persistent low-grade inflammation. Bullous keratopathy, uveitis reactivation and lens deposits were more common in the AC IOL group, although this did not reach statistical significance.