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Inflammation control key to surgical success for treating uveitis

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WAIKOLOA, Hawaii — In eyes with uveitis scheduled for surgery, inflammation control preoperatively and postoperatively is key to success, a speaker here said.

The “right way” to approach the inflamed eye is to ensure the eye is quiescent and free of inflammation for at least 3 months before surgery, Lisa J. Faia, MD, said at Retina 2019.

“As annoying and tedious as it can be, it makes a huge difference in these patients,” Faia said.

Etiology and type of uveitis are used as guides to preoperative control of inflammation, disease course, treatment response and rate of postoperative complications. Method of control also depends on the patient’s current anti-inflammatory regimen.

Patients with anterior uveitis usually do not need systemic steroid prophylaxis unless already on systemic immunosuppression, but patients with posterior uveitis usually require steroid prophylaxis before surgery, Faia said.

An algorithm for patients controlled with local therapies can be used to reduce inflammation. A patient controlled with drops can be treated with sub-Tenon’s or orbital floor injection of Kenalog (triamcinolone, Bristol-Myers Squibb) 40 mg several days before surgery. A surgeon can also use a dexamethasone biodegradable implant, which can be delivered intraoperatively depending on the surgeon’s comfort level.

A patient who is controlled with sub-Tenon’s Kenalog can have the injection ahead of time, and intraoperative delivery is also an option. If the patient is prone to cystoid macular edema, 2 mg to 4 mg of intravitreal Kenalog or a dexamethasone biodegradable implant can be used. Patients who require intravitreal Kenalog for control can have the injection ahead of time, usually 2 weeks before surgery. Surgeons can also consider an oral dose of prednisone 0. 5 mg/kg 3 to 5 days before surgery, she said.

If a patient’s disease is quiet for years, surgeons should not be fooled. Surgery incites inflammation, no matter how minimally invasive it is, Faia said. – by Patricia Nale, ELS, and Robert Linnehan

Reference:

Faia LJ. Surgical management of uveitis. Presented at: Retina 2019; Jan. 20-25, 2019; Waikoloa, Hawaii.

Disclosure: Faia reports no relevant financial disclosures.