Al-Essa Rakan S, Alfawaz Abdullah M
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Saudi J Ophthalmol. 2022 Feb 18;36(2):133-141. doi: 10.4103/sjopt.sjopt_147_21. eCollection 2022 Apr-Jun.
Cataract is a common cause of visual impairment in uveitic eyes. The management of cataract in patients with uveitis is often challenging due to pre-existing ocular comorbidities that may limit the visual outcomes. A meticulous preoperative ophthalmic evaluation is needed to assess the concomitant ocular pathologies with special emphasis on the status of the macula and optic nerve. Preoperative control of inflammation for at least 3 months before surgery is a key prognostic factor for successful surgical outcomes. Perioperative use of systemic and topical corticosteroids along with other immunosuppressive medications is crucial to decrease the risk of postoperative inflammation and cystoid macular edema (CME). Phacoemulsification with intraocular lens implantation is the surgical option of choice for most patients with uveitic cataract. Uveitic cataracts are typically complicated by the presence of posterior synechiae and poor pupil dilation, necessitating manual stretching maneuvers or pupil expansion devices to dilate the pupil intraoperatively. Patients must be closely monitored for postoperative complications such as excessive postoperative inflammation, CME, raised intraocular pressure, hypotony, and other complications. Good outcomes can be achieved in uveitic eyes after cataract extraction with appropriate handling of perioperative inflammation.
白内障是葡萄膜炎性眼病导致视力损害的常见原因。由于存在可能限制视力预后的眼部合并症,葡萄膜炎患者白内障的治疗往往具有挑战性。需要进行细致的术前眼科评估,以评估伴随的眼部病变,特别要关注黄斑和视神经的状况。术前至少3个月控制炎症是手术成功预后的关键因素。围手术期使用全身和局部皮质类固醇以及其他免疫抑制药物对于降低术后炎症和黄斑囊样水肿(CME)的风险至关重要。超声乳化白内障吸除联合人工晶状体植入术是大多数葡萄膜炎性白内障患者的首选手术方式。葡萄膜炎性白内障通常伴有后粘连和瞳孔散大不良,术中需要进行手动拉伸操作或使用瞳孔扩张装置来扩大瞳孔。必须密切监测患者术后并发症,如术后炎症过度、CME、眼压升高、低眼压和其他并发症。通过适当处理围手术期炎症,葡萄膜炎性眼病白内障摘除术后可取得良好效果。