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Surgery in Uveitis

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Uveitis

Part of the book series: Current Practices in Ophthalmology ((CUPROP))

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Abstract

Ocular complications are common in uveitis and may eventually require surgical management. These complications include cataracts, uveitic glaucoma, epiretinal membranes, band keratopathy, and retinal detachments, among many others. Perioperative surgical planning and inflammatory control are paramount in these complex cases to reduce the risk of postoperative complications such as persistent inflammation and/or cystoid macular edema, hypotony, ocular hypertension, and band keratopathy. This chapter discusses the special considerations and management steps to improve surgical outcomes in uveitic eyes.

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References

  1. Mehta S, Linton MM, Kempen JH. Outcomes of cataract surgery in patients with uveitis: a systematic review and meta-analysis. Am J Ophthalmol. 2014;158(4):676–92, e7.

    Article  PubMed  Google Scholar 

  2. Sen HN, et al. Cataract surgery outcomes in uveitis: the multicenter uveitis steroid treatment trial. Ophthalmology. 2016;123(1):183–90.

    Article  PubMed  Google Scholar 

  3. Mora P, et al. Perioperative prophylaxis to prevent recurrence following cataract surgery in uveitic patients: a two-centre, prospective, randomized trial. Acta Ophthalmol. 2016;94(6):e390–4.

    Article  CAS  PubMed  Google Scholar 

  4. Dada T, et al. Safety and efficacy of intraoperative intravitreal injection of triamcinolone acetonide injection after phacoemulsification in cases of uveitic cataract. J Cataract Refract Surg. 2007;33(9):1613–8.

    Article  PubMed  Google Scholar 

  5. Gupta A, et al. Intraoperative dexamethasone implant in uveitis patients with cataract undergoing phacoemulsification. Ocul Immunol Inflamm. 2013;21(6):462–7.

    Article  CAS  PubMed  Google Scholar 

  6. Larochelle MB, Smith J, Dacey MS. Dexamethasone intravitreal implant in the treatment of Uveitic macular Edema in the perioperative cataract setting: a case series. Am J Ophthalmol. 2016;166:149–53.

    Article  CAS  PubMed  Google Scholar 

  7. Ganesh SK, Mistry S. Phacoemulsification with intraocular lens implantation in pediatric uveitis: a retrospective study. Ocul Immunol Inflamm. 2016, 26:1–8.

    Google Scholar 

  8. Llop SM, Papaliodis GN. Cataract surgery complications in uveitis patients: a review article. Semin Ophthalmol. 2018;33(1):64–9.

    Article  PubMed  Google Scholar 

  9. Chu CJ, et al. Cataract surgery in uveitis: a multicentre database study. Br J Ophthalmol. 2017;101(8):1132–7.

    Article  PubMed  Google Scholar 

  10. Liu X, et al. Visual prognosis and associated factors of phacoemulsification and intraocular lens implantation in different uveitis entities in Han Chinese. Ocul Immunol Inflamm. 2017;25(3):349–55.

    Article  PubMed  Google Scholar 

  11. Powe NR, et al. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract patient outcome research team. Arch Ophthalmol. 1994;112(2):239–52.

    Article  CAS  PubMed  Google Scholar 

  12. Phatak S, Lowder C, Pavesio C. Controversies in intraocular lens implantation in pediatric uveitis. J Ophthalmic Inflamm Infect. 2016;6(1):12.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Abela-Formanek C, et al. Results of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in uveitic eyes with cataract comparison to a control group. J Cataract Refract Surg. 2002;28(7):1141–52.

    Article  PubMed  Google Scholar 

  14. Suresh PS, Jones NP. Phacoemulsification with intraocular lens implantation in patients with uveitis. Eye (Lond). 2001;15(Pt 5):621–8.

    Article  CAS  Google Scholar 

  15. El-shabrawi Y. Management of posterior synechiae, peripheral anterior synechiae, iridocorneal adhesions, and iridectomy. In: Becker M, Davis J, editors. Surgical management of inflammatory eye disease. Berlin: Springer; 2008.

    Google Scholar 

  16. Agraval U, et al. Optimum size of iridotomy in uveitis. Clin Exp Ophthalmol. 2015;43(7):692–6.

    Article  PubMed  Google Scholar 

  17. Krishna R, et al. Long-term follow-up of extracapsular cataract extraction and posterior chamber intraocular lens implantation in patients with uveitis. Ophthalmology. 1998;105(9):1765–9.

    Article  CAS  PubMed  Google Scholar 

  18. Belair ML, et al. Incidence of cystoid macular edema after cataract surgery in patients with and without uveitis using optical coherence tomography. Am J Ophthalmol. 2009;148(1):128–35. e2

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jurowski P, et al. Comparative analysis of the eye function and complications after removal of complicated cataract due to uveitis and senile cataract. Klin Ocz. 2005;107(7–9):421–5.

    Google Scholar 

  20. Sijssens KM, et al. Long-term ocular complications in aphakic versus pseudophakic eyes of children with juvenile idiopathic arthritis-associated uveitis. Br J Ophthalmol. 2010;94(9):1145–9.

    Article  CAS  PubMed  Google Scholar 

  21. Quinones K, et al. Outcomes of cataract surgery in children with chronic uveitis. J Cataract Refract Surg. 2009;35(4):725–31.

    Article  PubMed  Google Scholar 

  22. Woreta F, et al. Risk factors for ocular complications and poor visual acuity at presentation among patients with uveitis associated with juvenile idiopathic arthritis. Am J Ophthalmol. 2007;143(4):647–55.

    Article  PubMed  Google Scholar 

  23. Bodh SA, et al. Inflammatory glaucoma. Oman J Ophthalmol. 2011;4(1):3–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Horsley MB, Chen TC. The use of prostaglandin analogs in the uveitic patient. Semin Ophthalmol. 2011;26(4–5):285–9.

    Article  PubMed  Google Scholar 

  25. Miyake K, Ibaraki N. Prostaglandins and cystoid macular edema. Surv Ophthalmol. 2002;47(Suppl 1):S203–18.

    Article  PubMed  Google Scholar 

  26. Damji KF, et al. Selective laser trabeculoplasty versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial. Br J Ophthalmol. 2006;90(12):1490–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Damji KF, et al. Selective laser trabeculoplasty v argon laser trabeculoplasty: a prospective randomised clinical trial. Br J Ophthalmol. 1999;83(6):718–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Koktekir BE, Gedik S, Bakbak B. Bilateral severe anterior uveitis after unilateral selective laser trabeculoplasty. Clin Exp Ophthalmol. 2013;41(3):305–7.

    PubMed  Google Scholar 

  29. Kim DY, Singh A. Severe iritis and choroidal effusion following selective laser trabeculoplasty. Ophthalmic Surg Lasers Imaging. 2008;39(5):409–11.

    Article  PubMed  Google Scholar 

  30. Maleki A, et al. Selective laser trabeculoplasty in controlled uveitis with steroid-induced glaucoma. Ophthalmology. 2016;123(12):2630–2.

    Article  PubMed  Google Scholar 

  31. Spencer NA, Hall AJ, Stawell RJ. Nd:YAG laser iridotomy in uveitic glaucoma. Clin Exp Ophthalmol. 2001;29(4):217–9.

    Article  CAS  PubMed  Google Scholar 

  32. Athanasiadis Y, et al. Neodymium:YAG laser peripheral iridotomy as a possible cause of zonular dehiscence during phacoemulsification cataract surgery. Eye (Lond). 2010;24(8):1424–5.

    Article  CAS  Google Scholar 

  33. Schlote T, Derse M, Zierhut M. Transscleral diode laser cyclophotocoagulation for the treatment of refractory glaucoma secondary to inflammatory eye diseases. Br J Ophthalmol. 2000;84(9):999–1003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Heinz C, Koch JM, Heiligenhaus A. Transscleral diode laser cyclophotocoagulation as primary surgical treatment for secondary glaucoma in juvenile idiopathic arthritis: high failure rate after short term follow up. Br J Ophthalmol. 2006;90(6):737–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Aquino MC, et al. Micropulse versus continuous wave transscleral diode cyclophotocoagulation in refractory glaucoma: a randomized exploratory study. Clin Exp Ophthalmol. 2015;43(1):40–6.

    Article  PubMed  Google Scholar 

  36. Pantcheva MB, et al. Comparison of acute structural and histopathological changes in human autopsy eyes after endoscopic cyclophotocoagulation and trans-scleral cyclophotocoagulation. Br J Ophthalmol. 2007;91(2):248–52.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Neely DE, Plager DA. Endocyclophotocoagulation for management of difficult pediatric glaucomas. J AAPOS. 2001;5(4):221–9.

    Article  CAS  PubMed  Google Scholar 

  38. Lima FE, et al. A prospective, comparative study between endoscopic cyclophotocoagulation and the Ahmed drainage implant in refractory glaucoma. J Glaucoma. 2004;13(3):233–7.

    Article  PubMed  Google Scholar 

  39. Freedman SF, et al. Goniotomy for glaucoma secondary to chronic childhood uveitis. Am J Ophthalmol. 2002;133(5):617–21.

    Article  PubMed  Google Scholar 

  40. Bohnsack BL, Freedman SF. Surgical outcomes in childhood uveitic glaucoma. Am J Ophthalmol. 2013;155(1):134–42.

    Article  PubMed  Google Scholar 

  41. Ho CL, Walton DS. Goniosurgery for glaucoma secondary to chronic anterior uveitis: prognostic factors and surgical technique. J Glaucoma. 2004;13(6):445–9.

    Article  PubMed  Google Scholar 

  42. Richter GM, Coleman AL. Minimally invasive glaucoma surgery: current status and future prospects. Clin Ophthalmol. 2016;10:189–206.

    PubMed  PubMed Central  Google Scholar 

  43. Yakin M, et al. Short-term to long-term results of Ahmed glaucoma valve implantation for Uveitic glaucoma secondary to Behcet disease. J Glaucoma. 2017;26(1):20–6.

    Article  PubMed  Google Scholar 

  44. Tan AN, et al. Outcomes of severe uveitic glaucoma treated with Baerveldt implant: can blindness be prevented? Acta Ophthalmol. 2018;96(1):24–30.

    Article  PubMed  Google Scholar 

  45. Moore DB, et al. Improved surgical success of combined glaucoma tube shunt and Retisert((R)) implantation in uveitic eyes: a retrospective study. Ophthalmol Ther. 2015;4(2):103–13.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Almobarak FA, et al. Intermediate and long-term outcomes of Mitomycin C-enhanced trabeculectomy as a first glaucoma procedure in Uveitic glaucoma. J Glaucoma. 2017;26(5):478–85.

    Article  PubMed  Google Scholar 

  47. Kaburaki T, et al. Initial trabeculectomy with Mitomycin C in eyes with uveitic glaucoma with inactive uveitis. Eye (Lond). 2009;23(7):1509–17.

    Article  CAS  Google Scholar 

  48. Bettis DI, et al. Trabeculectomy with Mitomycin C or Ahmed valve implantation in eyes with Uveitic glaucoma. J Glaucoma. 2015;24(8):591–9.

    Article  PubMed  Google Scholar 

  49. Diamond JG, Kaplan HJ. Lensectomy and vitrectomy for complicated cataract secondary to uveitis. Arch Ophthalmol. 1978;96(10):1798–804.

    Article  CAS  PubMed  Google Scholar 

  50. Conrady CD, et al. The first case of Trypanosoma cruzi-associated retinitis in an immunocompromised host diagnosed by pan-organism PCR. Clin Infect Dis. 2018;67:141–3.

    Article  PubMed  Google Scholar 

  51. Quinones K, et al. Pars plana vitrectomy versus immunomodulatory therapy for intermediate uveitis: a prospective, randomized pilot study. Ocul Immunol Inflamm. 2010;18(5):411–7.

    Article  PubMed  Google Scholar 

  52. Trittibach P, et al. Vitrectomy for juvenile uveitis: prognostic factors for the long-term functional outcome. Eye (Lond). 2006;20(2):184–90.

    Article  CAS  Google Scholar 

  53. Secchi AG. Cataract surgery in exudative uveitis: effectiveness of total lens removal, anterior vitrectomy, and scleral fixation of PC IOLs. Eur J Ophthalmol. 2008;18(2):220–5.

    Article  CAS  PubMed  Google Scholar 

  54. Karampelas M, et al. Quantitative analysis of peripheral vasculitis, ischemia, and vascular leakage in uveitis using ultra-widefield fluorescein angiography. Am J Ophthalmol. 2015;159(6):1161–1168 e1.

    Article  PubMed  Google Scholar 

  55. Sohn EH, et al. Peripheral Cryoablation for treatment of active pars planitis: long-term outcomes of a retrospective study. Am J Ophthalmol. 2016;162:35–42 e2.

    Article  PubMed  Google Scholar 

  56. Pulido JS, et al. Results of peripheral laser photocoagulation in pars planitis. Trans Am Ophthalmol Soc. 1998;96:127–37; discussion 137-41

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Multicenter Uveitis Steroid Treatment Trial Research, G, et al. Randomized comparison of systemic anti-inflammatory therapy versus fluocinolone acetonide implant for intermediate, posterior, and panuveitis: the multicenter uveitis steroid treatment trial. Ophthalmology. 2011;118(10):1916–26.

    Article  Google Scholar 

  58. Ahmad ZM, et al. Combined posterior chamber intraocular lens, vitrectomy, Retisert, and pars plana tube in noninfectious uveitis. Arch Ophthalmol. 2012;130(7):908–13.

    Article  PubMed  Google Scholar 

  59. Sen HN, et al. Hypotony in patients with uveitis: the multicenter uveitis steroid treatment (MUST) trial. Ocul Immunol Inflamm. 2012;20(2):104–12.

    Article  PubMed  PubMed Central  Google Scholar 

  60. de Smet MD, Gunning F, Feenstra R. The surgical management of chronic hypotony due to uveitis. Eye (Lond). 2005;19(1):60–4.

    Article  Google Scholar 

  61. Yu EN, Paredes I, Foster CS. Surgery for hypotony in patients with juvenile idiopathic arthritis-associated uveitis. Ocul Immunol Inflamm. 2007;15(1):11–7.

    Article  PubMed  Google Scholar 

  62. Morse LS, McCuen BW 2nd. The use of silicone oil in uveitis and hypotony. Retina. 1991;11(4):399–404.

    Article  CAS  PubMed  Google Scholar 

  63. Kapur R, et al. Treating uveitis-associated hypotony with pars plana vitrectomy and silicone oil injection. Retina. 2010;30(1):140–5.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Hebson C, Martin D, Srivastava S. Intraocular pressure response in patients with hypotony and uveitis after intravitreal fluocinolone acetonide implantation. ARVO. 2009;50:3574.

    Google Scholar 

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Correspondence to Akbar Shakoor .

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Conrady, C.D., Hassman, L., Shakoor, A. (2020). Surgery in Uveitis. In: Lin, P. (eds) Uveitis . Current Practices in Ophthalmology. Springer, Singapore. https://doi.org/10.1007/978-981-15-0331-3_7

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  • DOI: https://doi.org/10.1007/978-981-15-0331-3_7

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