Eyeworld

SUMMER 2025 | EYEWORLD | 27 C by Ellen Stodola Editorial Co-Director About the physicians Anat Galor, MD Professor of Ophthalmology Bascom Palmer Eye Institute Miami, Florida Sanjay Kedhar, MD Clinical Professor of Ophthalmology Gavin Herbert Eye Institute University of California, Irvine Irvine, California Marissa Larochelle, MD Associate Professor University of Utah Department of Ophthalmology & Visual Sciences John A. Moran Eye Center Salt Lake City, Utah in an eye that's been recently inflamed," she said, adding that there will be a worse outcome with things like macular edema and hypotony. Sanjay Kedhar, MD, said that one of the primary things you'd be looking for is posterior synechiae or active uveitis. You can sometimes see subtle changes on the posterior cornea that suggests there's been previous inflammation. The other clues are things like band keratopa- thy, which can indicate that there's been inflam- mation in the past or some ongoing inflamma- tion. You want to do a complete dilated exam and look at the fundus to see if there's any chorioretinal scarring or pigmentary changes that might indicate that there's been inflamma- tion in the past. Patients with any history of uveitis are at increased risk for prolonged or more severe inflammation after cataract surgery and other postop complications like CME and epireti- nal membrane formation. They're also at an increased risk for PCO and an increase in IOP after surgery. Preoperative considerations Dr. Kedhar said it's very important to make sure any inflammation has been controlled and not active for the 3 months prior to surgery. "We W hen considering uveitis and cataract surgery, Anat Galor, MD, said you could be dealing with a patient who you know has uveitis, or you could have a pa- tient who develops a new uveitis after cataract surgery and you're trying to figure out what to do about it. Uveitis is not rare, she said, but it is not one disease, as the subtype and cause of inflamma- tion may differ from patient to patient. Beyond ocular inflammation, other signs that suggest a history of uveitis include synechiae of the iris to the lens, iris depigmentation, and/or keratic precipitates (inflammatory deposits) on the endothelium, Dr. Galor said. When preparing for a cataract procedure in a patient with uveitis, Dr. Galor said the disease must be controlled for 3 months prior to surgery. "Don't try to do surgery on a patient with active inflammation," she said. You also want to look at the eye and determine if there are factors that will need to be addressed at the time of surgery, like posterior synechiae. "Often times, uveitis patients are young, and their lens is soft, and there are different techniques to remove a soft versus hard lens," she said, adding that uveitis patients sometimes also have sticky cortex. Perioperatively, Dr. Galor treats her patients with non-infectious uveitis (inflammation not due to an infectious agent) with oral corticosteroids, which she starts 2 days prior to surgery, most commonly at a dose of 60 mg daily, then tapers the steroid off over a month. Marissa Larochelle, MD, noted that patients with uveitis develop cataracts earlier than oth- ers their age because the inflammation in uveitis can cause cataracts to form. The treatment, whether it's topical steroid drops, periocular ste- roid injections, or oral prednisone, can induce cataracts. The typical presentation of a cataract in these patients is a posterior subcapsular cataract from steroids, Dr. Larochelle said. The presence of uveitis and inflammation can have an impact on the cataract procedure, Dr. Larochelle said. "We never want to operate Considerations for uveitis and cataract surgery continued on page 28 Iris-optic capture of intraocular lens in a uveitis patient with poorly controlled postoperative inflammation Source: Sanjay Kedhar, MD

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