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    Cataract, glaucoma surgery in uveitis patients present added challenges

    These cases require more surgical management and considerations for better outcomes

    Cataract surgery in patients with coexisting uveitis is more challenging than managing either condition alone.

    Surgeons must answer a different set of questions and consider alternative management strategies, said Debra A. Goldstein, MD, FRSC, professor of ophthalmology and director of the Uveitis Service, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago.

    “When we talk about cataract surgery in uveitis, the big issue isn’t the surgery,” Dr. Goldstein said. “The big thing is who needs cataract surgery and how do we control the inflammation. That’s much more important than the surgery itself.”

    The first question is whether the cataract is the reason for the decreased vision and whether the patient would potentially benefit from surgery.

    With a clear lens, large cystoid macular edema (CME) would be hard to miss, but the diagnosis is more complicated when the lens is cloudy or the foveal light reflex is well preserved despite the presence of CME (Figure 1).“With uveitis patients, consider other causes for decreased vision before you run in and take out the cataract,” Dr. Goldstein said.

    When cataract surgery appears necessary, preoperative education or counseling is recommended, Dr. Goldstein said. If there are structural complications, such as macular atrophy (Figure 2), set reasonable expectations so that the patient is less likely to be upset if the postoperative acuity isn’t 20/20. Be as specific as possible, such as showing the patient a line on the eye chart that they should be able to read.

    Other preoperative management steps essential to improving the outcome are ensuring that the uveitis is quiet for at least 3 months, treating CME that may be worsened by surgery, and managing anterior segment inflammation to prevent anatomic complications. Options to quiet the eye include increased local therapy--posterior or anterior subtenon triamcinolone acetonide injections, injection of triamcinolone, preoperative dexamethasone implant, or perioperative coverage with oral prednisone.

    Type of uveitis

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