Combining Cataract and Uveitis Care BY MARISSA B. L AROCHELLE, MD
Cataract surgery in uveitis patients requires special consideration. Both intraocular inflammation and its first-line treatment (steroids) contribute to cataract progression, and cataracts are a main cause of decreased vision in uveitis patients. With careful perioperative planning and management, cataract surgery can be safe and effective in this patient population.
EXAMPLES:
PERIOPERATIVE PLANNING The most important aspect of successful cataract surgery in a
uveitis patient is control of inflammation in the perioperative period. In general, surgery should only be considered when inflammation has been quiescent for a minimum of three
months, ideally on an anti-inflammatory regimen with or without steroid-sparing immunomodulatory therapy (IMT), on acceptably safe doses of systemic corticosteroids (≤10 mg/daily). Several regimens involving a combination of topical, periocular, and/or systemic steroids exist to control inflammation in the perioperative cataract setting.
Oral prednisone 60 mg daily (or 1 mg/kg/day for patients weighing less than 60 kg) starting two or three days before surgery and tapering over approximately three weeks post- operatively. Initiation of topical steroid (prednisolone acetate 1%) and topical nonsteroidal anti-inflammatory drugs (NSAIDs) one week before surgery. Use of intravitreal implant (0.7 mg dexamethasone implant – Ozurdex) or subtenon’s injection of triamcinolone before surgery in patients with a history of recurrent macular edema. Pulse dose of intravenous methylprednisolone (ranging from 125-1000 mg) at the time of surgery. Subconjunctival or intracameral triamcinolone at the conclusion of the case.
Structural complications associated with uveitis can affect surgical planning. For example, fluctuating macular edema can alter axial length measurements and intraocular lens (IOL)
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