Outcome of phacoemulsification in patients with uveitis
Identifieur interne : 000A55 ( Ncbi/Checkpoint ); précédent : 000A54; suivant : 000A56Outcome of phacoemulsification in patients with uveitis
Auteurs : M A Elgohary ; P J Mccluskey ; H M A. Towler ; N. Okhravi ; R P Singh ; R. Obikpo ; S S LightmanSource :
- The British Journal of Ophthalmology [ 0007-1161 ] ; 2007.
English descriptors
- KwdEn :
- Adolescent, Adult, Aged, Aged, 80 and over, Cataract (complications), Epiretinal Membrane (etiology), Female, Humans, Lens Capsule, Crystalline (surgery), Macular Edema (etiology), Male, Middle Aged, Ocular Hypertension (etiology), Phacoemulsification (adverse effects), Prognosis, Recurrence, Retrospective Studies, Risk Factors, Survival Analysis, Treatment Outcome, Uveitis (complications), Visual Acuity.
- MESH :
- adverse effects : Phacoemulsification.
- complications : Cataract, Uveitis.
- etiology : Epiretinal Membrane, Macular Edema, Ocular Hypertension.
- surgery : Lens Capsule, Crystalline.
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Prognosis, Recurrence, Retrospective Studies, Risk Factors, Survival Analysis, Treatment Outcome, Visual Acuity.
Abstract
To examine the visual outcome and identify risk factors for postoperative uveitis, macular oedema and neodymium‐doped yttrium aluminium garnet (Nd:YAG) capsulotomy after phacoemulsification and intraocular lens (IOL) implantation in patients with uveitis.
This is a retrospective review of the medical records of 101 eyes of 101 patients. One eye was randomly selected for inclusion in patients who had bilateral surgery. Patients with juvenile arthritis, keratouveitis and lymphoma‐associated uveitis were excluded.
At the first postoperative and final visits, visual acuity was significantly better (p<0.001), and 64.4% and 71.3% of patients, respectively, had achieved ⩾2 Snellen's lines of visual improvement. The cumulative probability of doubling of the visual angle was 52% over 6 years of follow‐up, and this occurred at a higher rate in the presence of preoperative retinal or optic nerve lesions (HR (95% CI) 4.49 (1.41 to 14.29)). Within 3 months after operation, uveitis was more likely to develop in female patients (OR (95% CI) 6.21 (1.41 to 27.43)) and in the presence of significant intraoperative posterior synechiae (OR (95% CI) 8.43 (1.09 to 65.41)); macular oedema was more likely to develop in patients who developed postoperative uveitis (OR (95% CI) 7.45 (1.63 to 34.16)). Nd:YAG capsulotomy occurred at a higher rate in patients aged ⩽55 years (HR (95% CI) 2.28 (1.06, 4.93)) and in those with hydrogel IOLs (HR (95% CI) 3.71 (1.04 to 13.20)), and occurred at a lower rate in patients who had prophylactic systemic corticosteroids (HR (95% CI) 0.25 (0.11 to 0.59)), with plate‐haptic silicone IOLs (HR (95% CI) 0.23 (0.08 to 0.64)) and three‐piece silicone IOLs (HR (95% CI) 0.19 (0.05 to 0.74)) in comparison to those with polymethylmethacrylate IOLs.
Most patients with uveitis achieve improved visual acuity after phacoemulsification, but an increasing rate of visual loss is observed in those with pre‐existent macular or optic nerve lesions. Identifying patients who are at risk of postoperative complications should help in patient counselling and to pre‐empt these complications by using preoperative prophylactic corticosteroids, careful IOL selection and postoperative intensive corticosteroids.
Url:
DOI: 10.1136/bjo.2007.114801
PubMed: 17229800
PubMed Central: 1955648
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Outcome of phacoemulsification in patients with uveitis</title><author><name sortKey="Elgohary, M A" sort="Elgohary, M A" uniqKey="Elgohary M" first="M A" last="Elgohary">M A Elgohary</name></author><author><name sortKey="Mccluskey, P J" sort="Mccluskey, P J" uniqKey="Mccluskey P" first="P J" last="Mccluskey">P J Mccluskey</name></author><author><name sortKey="Towler, H M A" sort="Towler, H M A" uniqKey="Towler H" first="H M A" last="Towler">H M A. Towler</name></author><author><name sortKey="Okhravi, N" sort="Okhravi, N" uniqKey="Okhravi N" first="N" last="Okhravi">N. Okhravi</name></author><author><name sortKey="Singh, R P" sort="Singh, R P" uniqKey="Singh R" first="R P" last="Singh">R P Singh</name></author><author><name sortKey="Obikpo, R" sort="Obikpo, R" uniqKey="Obikpo R" first="R" last="Obikpo">R. Obikpo</name></author><author><name sortKey="Lightman, S S" sort="Lightman, S S" uniqKey="Lightman S" first="S S" last="Lightman">S S Lightman</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">17229800</idno><idno type="pmc">1955648</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955648</idno><idno type="RBID">PMC:1955648</idno><idno type="doi">10.1136/bjo.2007.114801</idno><date when="2007">2007</date><idno type="wicri:Area/Pmc/Corpus">000A52</idno><idno type="wicri:Area/Pmc/Curation">000A52</idno><idno type="wicri:Area/Pmc/Checkpoint">002439</idno><idno type="wicri:source">PubMed</idno><idno type="wicri:Area/PubMed/Corpus">001712</idno><idno type="wicri:Area/PubMed/Curation">001712</idno><idno type="wicri:Area/PubMed/Checkpoint">001392</idno><idno type="wicri:Area/Ncbi/Merge">000A55</idno><idno type="wicri:Area/Ncbi/Curation">000A55</idno><idno type="wicri:Area/Ncbi/Checkpoint">000A55</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Outcome of phacoemulsification in patients with uveitis</title><author><name sortKey="Elgohary, M A" sort="Elgohary, M A" uniqKey="Elgohary M" first="M A" last="Elgohary">M A Elgohary</name></author><author><name sortKey="Mccluskey, P J" sort="Mccluskey, P J" uniqKey="Mccluskey P" first="P J" last="Mccluskey">P J Mccluskey</name></author><author><name sortKey="Towler, H M A" sort="Towler, H M A" uniqKey="Towler H" first="H M A" last="Towler">H M A. Towler</name></author><author><name sortKey="Okhravi, N" sort="Okhravi, N" uniqKey="Okhravi N" first="N" last="Okhravi">N. Okhravi</name></author><author><name sortKey="Singh, R P" sort="Singh, R P" uniqKey="Singh R" first="R P" last="Singh">R P Singh</name></author><author><name sortKey="Obikpo, R" sort="Obikpo, R" uniqKey="Obikpo R" first="R" last="Obikpo">R. Obikpo</name></author><author><name sortKey="Lightman, S S" sort="Lightman, S S" uniqKey="Lightman S" first="S S" last="Lightman">S S Lightman</name></author></analytic><series><title level="j">The British Journal of Ophthalmology</title><idno type="ISSN">0007-1161</idno><idno type="eISSN">1468-2079</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Cataract (complications)</term><term>Epiretinal Membrane (etiology)</term><term>Female</term><term>Humans</term><term>Lens Capsule, Crystalline (surgery)</term><term>Macular Edema (etiology)</term><term>Male</term><term>Middle Aged</term><term>Ocular Hypertension (etiology)</term><term>Phacoemulsification (adverse effects)</term><term>Prognosis</term><term>Recurrence</term><term>Retrospective Studies</term><term>Risk Factors</term><term>Survival Analysis</term><term>Treatment Outcome</term><term>Uveitis (complications)</term><term>Visual Acuity</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Phacoemulsification</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Cataract</term><term>Uveitis</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Epiretinal Membrane</term><term>Macular Edema</term><term>Ocular Hypertension</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Lens Capsule, Crystalline</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Prognosis</term><term>Recurrence</term><term>Retrospective Studies</term><term>Risk Factors</term><term>Survival Analysis</term><term>Treatment Outcome</term><term>Visual Acuity</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Aims</title><p>To examine the visual outcome and identify risk factors for postoperative uveitis, macular oedema and neodymium‐doped yttrium aluminium garnet (Nd:YAG) capsulotomy after phacoemulsification and intraocular lens (IOL) implantation in patients with uveitis.</p></sec><sec><title>Method</title><p>This is a retrospective review of the medical records of 101 eyes of 101 patients. One eye was randomly selected for inclusion in patients who had bilateral surgery. Patients with juvenile arthritis, keratouveitis and lymphoma‐associated uveitis were excluded.</p></sec><sec><title>Results</title><p>At the first postoperative and final visits, visual acuity was significantly better (p<0.001), and 64.4% and 71.3% of patients, respectively, had achieved ⩾2 Snellen's lines of visual improvement. The cumulative probability of doubling of the visual angle was 52% over 6 years of follow‐up, and this occurred at a higher rate in the presence of preoperative retinal or optic nerve lesions (HR (95% CI) 4.49 (1.41 to 14.29)). Within 3 months after operation, uveitis was more likely to develop in female patients (OR (95% CI) 6.21 (1.41 to 27.43)) and in the presence of significant intraoperative posterior synechiae (OR (95% CI) 8.43 (1.09 to 65.41)); macular oedema was more likely to develop in patients who developed postoperative uveitis (OR (95% CI) 7.45 (1.63 to 34.16)). Nd:YAG capsulotomy occurred at a higher rate in patients aged ⩽55 years (HR (95% CI) 2.28 (1.06, 4.93)) and in those with hydrogel IOLs (HR (95% CI) 3.71 (1.04 to 13.20)), and occurred at a lower rate in patients who had prophylactic systemic corticosteroids (HR (95% CI) 0.25 (0.11 to 0.59)), with plate‐haptic silicone IOLs (HR (95% CI) 0.23 (0.08 to 0.64)) and three‐piece silicone IOLs (HR (95% CI) 0.19 (0.05 to 0.74)) in comparison to those with polymethylmethacrylate IOLs.</p></sec><sec><title>Conclusion</title><p>Most patients with uveitis achieve improved visual acuity after phacoemulsification, but an increasing rate of visual loss is observed in those with pre‐existent macular or optic nerve lesions. Identifying patients who are at risk of postoperative complications should help in patient counselling and to pre‐empt these complications by using preoperative prophylactic corticosteroids, careful IOL selection and postoperative intensive corticosteroids.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Elgohary, M A" sort="Elgohary, M A" uniqKey="Elgohary M" first="M A" last="Elgohary">M A Elgohary</name><name sortKey="Lightman, S S" sort="Lightman, S S" uniqKey="Lightman S" first="S S" last="Lightman">S S Lightman</name><name sortKey="Mccluskey, P J" sort="Mccluskey, P J" uniqKey="Mccluskey P" first="P J" last="Mccluskey">P J Mccluskey</name><name sortKey="Obikpo, R" sort="Obikpo, R" uniqKey="Obikpo R" first="R" last="Obikpo">R. Obikpo</name><name sortKey="Okhravi, N" sort="Okhravi, N" uniqKey="Okhravi N" first="N" last="Okhravi">N. Okhravi</name><name sortKey="Singh, R P" sort="Singh, R P" uniqKey="Singh R" first="R P" last="Singh">R P Singh</name><name sortKey="Towler, H M A" sort="Towler, H M A" uniqKey="Towler H" first="H M A" last="Towler">H M A. Towler</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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