Surgeon: Make sure inflammation is well controlled before removing cataract in uveitic eyes

SAN FRANCISCO — Cataract surgeons should delay cataract removal in patients with uveitis until well after inflammation is controlled, according to a speaker here.

C. Stephen Foster

Control of inflammation is predicated on understanding the cause of the uveitis, followed by treatment appropriate to the cause, C. Stephen Foster, MD, said at the joint meeting of the American Academy of Ophthalmology and the Pan-American Association of Ophthalmology.

Dr. Foster recommended using a "stepladder approach" to quieting inflammation, with the goal of achieving steroid-free remission. Start with topical or regional injection of nonsteroidal agents, he said, followed by oral, intravenous and intraocular administration.

He said that ophthalmologists can learn from the experience of rheumatologists in aggressively reducing inflammation. However, "the eye is so much less tolerant to inflammation than are the joints."

"I have, for about 25 years, recommended waiting at least 3 months before doing cataract surgery after the eye is quiet, remain on the program that got you there and the patient into remission, and beginning 1 day preop with topical nonsteroidals and oral nonsteroidal anti-inflammatory drugs and steroids," Dr. Foster said.