Van Gelder Russell N, Leveque Thellea K
Department of Ophthalmology, University of Washington Medical School, Seattle, Washington 98195, USA.
Curr Opin Ophthalmol. 2009 Jan;20(1):42-5. doi: 10.1097/ICU.0b013e32831b9b22.
To describe recent evidence from the literature concerning optimal treatment of cataract in patients with concomitant uveitis.
Optimal treatment of cataract in the setting of uveitis requires optimal management of uveitis, including appropriate diagnostic workup and scrupulous attention to preoperative preparation, intraoperative technique, and postoperative management. Recent literature suggests high rates of recurrence of certain forms of uveitis (such as ocular toxoplasmosis) after surgery, suggesting that perioperative prophylaxis may be warranted. Placement of intraocular lenses in the setting of certain forms of uveitis, such as juvenile idiopathic arthritis-associated uveitis, remains controversial. Although excellent outcomes can be achieved with many types of intraocular lenses, several recent studies have suggested that the incidence of postoperative complications may be lower in patients receiving acrylic intraocular lenses compared with other materials. Recent long-term outcome studies in cohorts of uveitis patients undergoing cataract surgery suggest very good outcomes in the majority of patients.
Provided the unique challenges of cataract surgery in the setting of uveitis are recognized and appropriately addressed, excellent visual outcomes can be achieved in most patients.
描述近期文献中有关伴有葡萄膜炎患者白内障最佳治疗的证据。
在葡萄膜炎背景下白内障的最佳治疗需要对葡萄膜炎进行最佳管理,包括适当的诊断检查以及对术前准备、术中技术和术后管理的严格关注。近期文献表明某些形式的葡萄膜炎(如眼部弓形虫病)术后复发率较高,提示围手术期预防可能是必要的。在某些形式的葡萄膜炎(如青少年特发性关节炎相关性葡萄膜炎)情况下植入人工晶状体仍存在争议。虽然许多类型的人工晶状体都能取得良好效果,但最近的几项研究表明,与其他材料相比,接受丙烯酸人工晶状体的患者术后并发症发生率可能更低。近期对接受白内障手术的葡萄膜炎患者队列的长期预后研究表明,大多数患者预后良好。
只要认识到葡萄膜炎背景下白内障手术的独特挑战并适当应对,大多数患者都能获得良好的视觉效果。