Range of considerations needed for cataract patients with uveitis
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When performing cataract surgery in a patient with uveitis, it is important to both plan ahead and plan for contingencies, Jessica B. Ciralsky, MD, said at the virtual American Academy of Ophthalmology annual meeting.
“Cataracts are a common problem in chronic uveitis patients because they often have sustained inflammation and prolonged steroid use, so you’re bound to encounter these patients in your practice,” Ciralsky said.
Ciralsky brings a plan, a backup plan and a contingency tray to the operating room because cases have potential to be difficult.
Knowing the cause of uveitis is important because different underlying conditions require different treatment strategies, Ciralsky said. Surgeons should wait for a period of disease quiescence of at least 3 months and preferably 6 months before operating, Ciralsky said.
“Plan ahead both before you get to the operating room as well as once you’re in there. You don’t want to get to the operating room and then have to abort a case because the view is too difficult to see through,” Ciralsky said.
It is important to rule out other pathology such as band keratopathy, glaucoma or retinal disease. If the patient needs glaucoma surgery, Ciralsky said she prefers sequential procedures “because there’s a higher rate of failure for the filtering procedure if they’re done together. For retina, I’ll do either joint or sequential, depending on the circumstance.”
Control of the iris is a must, according to Ciralsky, and careful selection of an IOL is also imperative.
Before placing the IOL, Ciralsky makes sure surgery is meticulously performed, ensuring that all lens material is removed and there is good cortical cleanup.
“If they are a child or have chronic, uncontrolled uveitis, I will consider leaving them aphakic,” Ciralsky said.
Finally, it is important to actively manage, or comanage corticosteroids, she said.
“You need to think about these patients pre-, peri- and postop,” she said.
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Ciralsky JB. Phaco with uveitis. Presented at: American Academy of Ophthalmology annual meeting; Nov. 13-15, 2020 (virtual meeting).
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