Cataract Surgery in Patients with Uveitis: Preoperative and Surgical Considerations

Cataract is one of the most frequent visual impairment complications of uveitis, accounting for up to 40% of the visual loss seen in these patients. In general, uveitis patients differ from the general cataract population in that they are younger and have a higher rate of comorbidities, however the rates of inflammatory sequelae vary markedly among uveitic entities. Cataract development may be influenced by the cause and duration of uveitis, the degree of inflammation control, and the use of corticosteroid therapy. Cataract surgery in patients with uveitis represents a serious challenge due to pre-existing ocular comorbidities that may limit the visual outcome and difficult the surgical procedure; the need for preoperative control of inflammation; and the efficacy of postoperative management to avoid immediate and late ocular complications. A detailed ophthalmologic exam prior to surgery is essential to know the status of pre-existing pathologic changes, adjust the medical therapy to achieve absolute control of inflammation, establish a surgical plan, and deliver an objective visual prognosis to the patient or the relatives. The key point to surgical success is the absolute control of inflammation, meaning no cells in the anterior chamber for at least 3 months prior to surgery. Today, minimally invasive phacoemulsification with acrylic foldable intraocular lens implantation is the standard of care for most patients with uveitis. It must be taken into consideration that higher rates of intraoperative and postoperative complications may occur. Vision-limiting pathology related to pre-existing uveitis complications are the major contributing factors for limited postoperative visual outcome.