Doing cataract surgery in an eye with a prior history of uveitis can be more challenging than a typical case. We don’t want to do cataract surgery in an eye that has active inflammation from the uveitis, so it is important for the eye to be quiescent for at least a few months.
In cases of anterior uveitis, we often find posterior synechiae where the iris is adherent to the anterior lens capsule thereby limiting pupil dilation. We can usually break these synechiae relatively easily and expand the pupil. In some cases there can be a pupillary membrane as a result of the prior inflammation that will need to be removed prior to pupil expansion.
We can use methods to enlarge the pupil either by stretching or using rings / hooks. During the surgery we want to be efficient and limit the amount of inflammation that we will cause. Injecting preservative-free triamcinolone into the anterior chamber at the end of surgery can help with post-op inflammation control. In some cases, we may also choose to place a depot injection of triamcinolone in the sub-Tenon’s space. Rarely, systemic steroids are used to help control post-op inflammation and to limit the risk of a recurrence of the uveitis.
In the post-op period these patients should be monitored for resolution of their inflammation, which can take longer than a typical patient. In some cases, increased dosing of topical steroids is helpful. These patients also have a higher risk of cystoid macular edema, so using topical NSAIDs (non-steroidal anti-inflammatory drugs) can help limit this.
Click below to see this resident case of cataract surgery in a uveitic eye:
