Cataract surgery in uveitic eyes produces good vision in most cases

The results of this systematic review and meta-analysis indicate that cataract surgery in uveitis patients can result in normal or near-normal visual acuity in the majority of cases.

The meta-analysis included 89 studies. They found that among eyes with quiet or mostly quiet uveitis, 68% of patients who underwent phacoemulsification achieved visual acuity of 20/40 or better, as did 72% who underwent extracapsular cataract extraction and 40% following pars plana lensectomy. Significantly more eyes that underwent cataract surgery with IOL implantation than eyes left aphakic achieved 20/40 or better postoperatively (71% vs. 52%).

Patients with uveitis who underwent cataract surgery and received acrylic or heparin surface-modified polymethylmethacrylate lenses had better visual outcomes than those who received non-heparin surface-modified polymethylmethacrylate or silicone IOLs. Patients who had active uveitis at the time of cataract surgery had significantly worse visual outcomes.

Posterior uveitis tended to do worse than anterior uveitis probably because of inflammation involving visually important structures, such as the macula and optic nerve, which led to more severe visual disabilities than in patients with anterior uveitis. On the other hand, visual acuity outcomes were intermediate among eyes with juvenile idiopathic arthritis uveitis in which preoperatively uveitic activity was not specified, with approximately 65% of eyes achieving 20/40 or better.

These results underscore the fact that future studies should focus on homogenous groups of patients with uveitic disorders who had the same surgical procedure and the same type of IOL implantation. Studies including heterogeneous group of patients should be avoided, and patients with infectious versus immune-mediated disorders should be assessed separately.