Eyeworld

SUMMER 2025 | EYEWORLD | 31 C "new" lens problem, such as a one-piece acrylic lens in an improper position. Dr. Galor said that acrylic lenses are soft, so you may have placed the lens inside the capsular bag at the time of surgery, but one haptic can migrate and end up in the sulcus, leading to a chronic inflammatory state. At the slit lamp, it is important to look for any retained lens fragments and pay attention to lens position. Finally, the patient can also have an undiagnosed systemic issue driving the ocular inflammation. As such, a targeted labora- tory evaluation is warranted. After reversible issues are identified and addressed, uveitis treatment is guided by in- flammation type, Dr. Galor said. Acute inflam- mation refers to inflammation that is treated for an adequate period of time (8–10 weeks) and when treatment is stopped, the patient does not have a recurrence for at least 3 months. In this case, uveitis is often treated episodically. However, if inflammation recurs while on a tapering treatment, or prior to 3 months, the uveitis is considered chronic and needs chronic treatment. This may be in the form of topical corticosteroids, in the case of anterior uveitis, or with other strategies (oral immunomodulatory therapies), as appropriate, Dr. Galor said. "There are some people where you cannot find a cause, but the inflammation still needs to be treated. It is necessary to treat the eye even if we do not understand what is causing the inflammation." Other treatments and considerations Dr. Larochelle noted that the Moran Eye Center has been using intracameral tPA, which is an anti-fibrinolytic. They inject it into the anterior chamber at the end of the case in an attempt to prevent a fibrinous reaction postop. "Some people will inject it once they see fibrin form, but we're doing it prophylactically," she said. Dr. Larochelle added that immunosuppres- sion is key. Patients are typically well con- trolled on Humira (adalimumab, AbbVie) or methotrexate, and that needs to be maintained through their operative period. "The control that these medications allow with uveitis is con- tributing to good outcomes in cataract surgery because the inflammatory control is so much better with the newer medications and biolog- ics," she said. Dr. Kedhar said there have been some newer developments in handling these cases, noting longer duration intravitreal options for steroids. He mentioned studies using Ozurdex injections at the time of surgery to minimize inflammation, with results similar to the use of oral steroids in the perioperative period. "We also have more widespread use of immunosuppressive medications to control in- flammation," he said, adding that this has been helpful to reduce the risk of inflammation after surgery. Dr. Galor said in addition to the established immunosuppressant medications used in uve- itis, there are a number of newer medications approved for other autoimmune diseases that are less often repurposed for uveitis. Dr. Galor specifically noted other anti-TNFa therapies, IL-17 inhibitors, and JAK inhibitors. Even old medications, such as corticoste- roids, are being investigated for improvements, she said. People are trying to figure out if they can make more potent steroids with less side ef- fects. They are looking at different formulations, like using nanoparticles to improve retention time, and new delivery systems, Dr. Galor said. "The field is constantly evolving, so when it comes to therapies, there are always new things that we're looking to borrow from rheumatolo- gy or from allergy to try to see if they can help our patients with uveitis," she said. Anterior capsular phimosis after cataract surgery in a patient with Vogt-Koyanagi-Harada syndrome Source: Sanjay Kedhar, MD Contact Galor: AGalor@med.miami.edu Kedhar: skedhar@hs.uci.edu Larochelle: Marissa.Larochelle@hsc.utah.edu

• Cover