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Uveitis can complicate cataract surgery and limit vision gains
Despite complications, patients with uveitis who undergo cataract surgery can still experience positive visual outcomes.
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Postoperative vision gains in eyes with uveitis that undergo cataract surgery are about a line less compared with healthy eyes that undergo the same procedure, according to the results of a U.K. database study.
There were much higher rates of intraoperative complications in uveitic eyes, and more combined procedures were performed in uveitic eyes compared with a control group of non-uveitic eyes undergoing cataract surgery, Colin J. Chu, PhD, FRCOphth, of the University of Bristol, told Ocular Surgery News.
“This is a large real-world United Kingdom database study of 1,173 eyes with a diagnosis of uveitis undergoing cataract surgery that were retrospectively examined and compared to a reference group of 95,573 eyes without ocular disease. Overall, most eyes gained vision, but those with uveitis were on average around a line worse than would be expected compared to controls, despite our contemporary practice,” he said.
Worse visual acuity
The study included data from eight independent NHS hospital ophthalmology departments in the United Kingdom that used the same electronic medical records system. The study period contained patients treated from Jan. 1, 2010, to Dec. 31, 2014.
The dataset included 111,641 eyes undergoing cataract surgery in the study period. In the cohort, 14,895 eyes were excluded because the diabetic status was not recorded. The final study cohort included 1,173 uveitic eyes and 95,573 eyes classified into the non-uveitis control group.
On average, uveitic eyes had a preoperative average of 0.87 logMAR units compared with 0.65 logMAR units in the control group eyes, shorter axial lengths and a higher incidence of ocular co-pathology, including glaucoma.
The uveitic eye group had worse visual acuity outcomes at all three follow-up points in the study. At the final follow-up point of 12 to 24 weeks postoperative, the mean visual acuity for uveitic eyes was 0.41 logMAR units compared with 0.27 logMAR units for the control group eyes, Chu said. As a cohort, both groups of eyes improved by three to four lines on the logMAR chart.
More potential complications
Additionally, the uveitic group of eyes had more potential postoperative complications and adverse events during the cataract surgery.
“About 25% of eyes with uveitis were recorded as having a small pupil compared to 3% in controls. Even with experienced surgeons operating, there was a higher rate of posterior capsule rupture,” Chu said.
Eyes in the uveitic group had higher IOP and twice the rate of postoperative macular edema compared with the control group.
More marked visual harm
Additionally, 3.8% of uveitic eyes experienced marked visual harm, defined as a greater than 0.3 logMAR unit loss from baseline to 12 to 24 weeks follow-up, compared with 2.9% of eyes in the control group. However, this was not a statistically significant difference.
“This is the largest data set published on cataract surgery in uveitis, and whilst there are limitations in performing a retrospective analysis, it is strengthened by its real-world nature and so is more applicable to practicing ophthalmologists than the artificial setting of a clinical trial. It highlights that we are actually doing pretty well, as eyes are only one line worse off, but that is clearly despite managing the many other considerations,” Chu said. – by Robert Linnehan
- Reference:
- Chu CJ, et al. Br J Ophthalmol. 2017;doi:10.1136/bjophthalmol-2016-309047.
- For more information:
- Colin J. Chu, PhD, FRCOphth, can be reached at Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, United Kingdom; email: colin.chu@bristol.ac.uk.
Disclosure: Chu reports no relevant financial disclosures.