Iatrogenic uveitis management depends on underlying cause
WAILEA, Hawaii — Sometimes intraocular surgery itself results in some manifestation of uveitis, for which there is no clear definition in the literature, Yashi S. Modi, MD, said at Hawaiian Eye.
“My definition is anterior chamber cell, vitreous cell, pigment dispersion, which could involve corneal endothelium, AC, around the lens and in vitreous; there could be CME, and there could be flare and pain. Most notably, this is not present prior to surgery,” Modi said.
When someone has intraocular surgery and subsequent iatrogenic uveitis, Modi first determines whether the inflammation and pigment dispersion is permanent or transient.
When causes are transient, “great outcomes” can frequently be achieved without invasive treatment, he said, but when causes are permanent, intervention is needed to break the inflammatory or pigmentary cascade.
A systematic evaluation to define transient and permanent causes of inflammation and pigment dispersion allows for a more targeted approach to management, he said.
Permanent causes include broken bag, zonular dialysis, vitreous loss causing vitreous traction, retained lens fragments, IOL malposition, UGH syndrome and chronic endophthalmitis.
“In the absence of an intervention, the patient will not get better,” he said.
When managing the more difficult cases of IOL malposition, Modi uses conservative measures first, such as IOP control and control of cystoid macular edema with topical or intravitreal steroids before considering surgery.
In cases of chronic endophthalmitis, cultures are frequently negative and difficult to detect, he said. Oftentimes, the IOL needs to be removed.
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Modi YS, Iatrogenic uveitis: A diagnostic and management approach. Presented at: Hawaiian Eye; May 8-14, 2021; Wailea, Hawaii.
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