TY  - JOUR
T1  - Decision‐Making Factors Influencing Surgical Management and Visual Outcomes in Uveitic Cataracts: A Prospective Observational Study
AU - Mishra, Anoop 
JO  - Research Journal of Medical Sciences
VL  - 13
IS  - 6
SP  - 122
EP  - 127
PY  - 2019
DA  - 2001/08/19
SN  - 1815-9346
DO  - makrjms.2019.122.127
UR  - https://makhillpublications.co/view-article.php?doi=makrjms.2019.122.127
KW  - Uveitic cataract
KW  - cataract operation
KW  - inactive inflammation
KW  - phacoemulsification
KW  - intraocular lens
KW  - visual acuity
KW  - cystoid macular oedema
KW  - perioperative steroids
AB  - Uveitic cataracts are a major cause of vision loss in patients with chronic
intraocular inflammatory disease. Surgical intervention of these cataracts
is difficult as a result of the difficulties of persistent inflammation, timing
of surgery and perioperative management. The purpose of this study is
to assess the clinical and surgical determinants of postoperative visual
results and complications in patients treated for cataracts associated with
uveitis. The study was a Prospective observational case series of 123
uveitic cataract patients conducted at Department of Ophthalmology of
Era’s Lucknow Medical College and Hospitals. Demographic and all the
clinical and inflammation status data were collected. Details of the time
of surgery, the technique employed, type of IOL used and the pre and
postoperative steroid regimens were recorded. The patients were
followed for 3 months after surgery in order to evaluate the visual acuity
improvement and the rates of complications. Statistical analysis
incorporated univariate and multivariate logistic regression for the
estimation of the risk of visual improvement. The average age of patients
was 42.5±14.3 years and anterior uveitis was the most frequent type
(50.4%). Surgery was indicated in 66.7% of patients after minimum of 3
months of quiescence. The operative technique was phacoemulsification
with foldable acrylic IOLs. At 3 months, 71.5% in the treatment groups
gained 2 Snellen lines in ETDRS visual acuity. Independently, delayed
surgery after adequate inflammation was a predictor of better vision (OR
2.8., 95% CI: 1.2‐6.5., p = 0.015). The main postoperative complications
were cystoid macular edema in 14.6% of eyes and increased intraocular
pressure in 12.2%. Modifying the timing of cataract surgery according to
inflammatory quiescence markedly improves the visual prognosis in
patients with uveitic cataract. Phacoemulsification using foldable acrylic
IOLs plus personalized perioperative steroid therapy is safe and effective.
Individualised surgical planning based on the inflammatory status is
important to achieve optimal functional recovery and to avoid
complications.
ER  -