Outcome of phacoemulsification in patients with uveitis
Identifieur interne : 002027 ( Istex/Corpus ); précédent : 002026; suivant : 002028Outcome 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 :
- British Journal of Ophthalmology [ 0007-1161 ] ; 2007-07.
Abstract
Aims: 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. Method: 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. Results: 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. Conclusion: 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.
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DOI: 10.1136/bjo.2006.109660
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<record><TEI wicri:istexFullTextTei="biblStruct"><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><affiliation><mods:affiliation>Moorfields Eye Hospital, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Tanta University Ophthalmology Hospital, Tanta, Egypt</mods:affiliation></affiliation></author><author><name sortKey="Mccluskey, P J" sort="Mccluskey, P J" uniqKey="Mccluskey P" first="P J" last="Mccluskey">P J Mccluskey</name><affiliation><mods:affiliation>Royal Prince Alfred Hospital, Sydney, New South Wales, Australia</mods:affiliation></affiliation></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><affiliation><mods:affiliation>Whipps Cross University Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Okhravi, N" sort="Okhravi, N" uniqKey="Okhravi N" first="N" last="Okhravi">N. Okhravi</name><affiliation><mods:affiliation>Moorfields Eye Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Singh, R P" sort="Singh, R P" uniqKey="Singh R" first="R P" last="Singh">R P Singh</name><affiliation><mods:affiliation>Royal Prince Alfred Hospital, Sydney, New South Wales, Australia</mods:affiliation></affiliation></author><author><name sortKey="Obikpo, R" sort="Obikpo, R" uniqKey="Obikpo R" first="R" last="Obikpo">R. Obikpo</name><affiliation><mods:affiliation>Whipps Cross University Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Lightman, S S" sort="Lightman, S S" uniqKey="Lightman S" first="S S" last="Lightman">S S Lightman</name><affiliation><mods:affiliation>Moorfields Eye Hospital, London, UK</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:81BEA7A9CAC0F7C8AA51E2570BAC02B0924139B9</idno><date when="2007" year="2007">2007</date><idno type="doi">10.1136/bjo.2006.109660</idno><idno type="url">https://api.istex.fr/document/81BEA7A9CAC0F7C8AA51E2570BAC02B0924139B9/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">002027</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" 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><affiliation><mods:affiliation>Moorfields Eye Hospital, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Tanta University Ophthalmology Hospital, Tanta, Egypt</mods:affiliation></affiliation></author><author><name sortKey="Mccluskey, P J" sort="Mccluskey, P J" uniqKey="Mccluskey P" first="P J" last="Mccluskey">P J Mccluskey</name><affiliation><mods:affiliation>Royal Prince Alfred Hospital, Sydney, New South Wales, Australia</mods:affiliation></affiliation></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><affiliation><mods:affiliation>Whipps Cross University Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Okhravi, N" sort="Okhravi, N" uniqKey="Okhravi N" first="N" last="Okhravi">N. Okhravi</name><affiliation><mods:affiliation>Moorfields Eye Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Singh, R P" sort="Singh, R P" uniqKey="Singh R" first="R P" last="Singh">R P Singh</name><affiliation><mods:affiliation>Royal Prince Alfred Hospital, Sydney, New South Wales, Australia</mods:affiliation></affiliation></author><author><name sortKey="Obikpo, R" sort="Obikpo, R" uniqKey="Obikpo R" first="R" last="Obikpo">R. Obikpo</name><affiliation><mods:affiliation>Whipps Cross University Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Lightman, S S" sort="Lightman, S S" uniqKey="Lightman S" first="S S" last="Lightman">S S Lightman</name><affiliation><mods:affiliation>Moorfields Eye Hospital, London, UK</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">British Journal of Ophthalmology</title><title level="j" type="abbrev">Br J Ophthalmol</title><idno type="ISSN">0007-1161</idno><idno type="eISSN">1468-2079</idno><imprint><publisher>BMJ Publishing Group Ltd.</publisher><pubPlace>BMA House, Tavistock Square, London, WC1H 9JR</pubPlace><date type="published" when="2007-07">2007-07</date><biblScope unit="volume">91</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="916">916</biblScope></imprint><idno type="ISSN">0007-1161</idno></series><idno type="istex">81BEA7A9CAC0F7C8AA51E2570BAC02B0924139B9</idno><idno type="DOI">10.1136/bjo.2006.109660</idno><idno type="href">bjophthalmol-91-916.pdf</idno><idno type="PMID">17229800</idno><idno type="local">0910916</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0007-1161</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Aims: 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. Method: 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. Results: 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. Conclusion: 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.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>M A Elgohary</name><affiliations><json:string>Moorfields Eye Hospital, London, UK</json:string><json:string>Tanta University Ophthalmology Hospital, Tanta, Egypt</json:string></affiliations></json:item><json:item><name>P J McCluskey</name><affiliations><json:string>Royal Prince Alfred Hospital, Sydney, New South Wales, Australia</json:string></affiliations></json:item><json:item><name>H M A Towler</name><affiliations><json:string>Whipps Cross University Hospital, London, UK</json:string></affiliations></json:item><json:item><name>N Okhravi</name><affiliations><json:string>Moorfields Eye Hospital, London, UK</json:string></affiliations></json:item><json:item><name>R P Singh</name><affiliations><json:string>Royal Prince Alfred Hospital, Sydney, New South Wales, Australia</json:string></affiliations></json:item><json:item><name>R Obikpo</name><affiliations><json:string>Whipps Cross University Hospital, London, UK</json:string></affiliations></json:item><json:item><name>S S Lightman</name><affiliations><json:string>Moorfields Eye Hospital, London, UK</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Paediatrics</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Ophthalmologic surgical procedures</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>BCVA, best-corrected visual acuity</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>ERM, epiretinal membrane</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>IOL, intraocular lens</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>IOP, intraocular pressure</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>logMAR, log minimum angle of resolution</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Nd:YAG, neodymium-doped yttrium aluminium garnet</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PCO, posterior capsular opacification</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PMMA, polymethylmethacrylate</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Aims: 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. Method: 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. Results: 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. Conclusion: 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.</abstract><qualityIndicators><score>7.414</score><pdfVersion>1.2</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>10</keywordCount><abstractCharCount>2263</abstractCharCount><pdfWordCount>4414</pdfWordCount><pdfCharCount>30494</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>338</abstractWordCount></qualityIndicators><title>Outcome of phacoemulsification in patients with uveitis</title><pmid><json:string>17229800</json:string></pmid><genre.original><json:string>other</json:string></genre.original><genre><json:string>other</json:string></genre><host><volume>91</volume><pages><first>916</first></pages><issn><json:string>0007-1161</json:string></issn><issue>7</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-2079</json:string></eissn><title>British Journal of Ophthalmology</title></host><publicationDate>2007</publicationDate><copyrightDate>2007</copyrightDate><doi><json:string>10.1136/bjo.2006.109660</json:string></doi><id>81BEA7A9CAC0F7C8AA51E2570BAC02B0924139B9</id><score>1</score><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/81BEA7A9CAC0F7C8AA51E2570BAC02B0924139B9/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/81BEA7A9CAC0F7C8AA51E2570BAC02B0924139B9/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/81BEA7A9CAC0F7C8AA51E2570BAC02B0924139B9/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Outcome of phacoemulsification in patients with uveitis</title><respStmt xml:id="ISTEX-API" resp="Références bibliographiques récupérées via GROBID" name="ISTEX-API (INIST-CNRS)"></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd.</publisher><pubPlace>BMA House, Tavistock Square, London, WC1H 9JR</pubPlace><availability><p>BMJ</p></availability><date>2007-01-03</date></publicationStmt><notesStmt><note>Correspondence to: Professor S S Lightman Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK; s.lightman@ucl.ac.uk</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Outcome of phacoemulsification in patients with uveitis</title><author><persName><forename type="first">M A</forename><surname>Elgohary</surname></persName><affiliation>Moorfields Eye Hospital, London, UK</affiliation><affiliation>Tanta University Ophthalmology Hospital, Tanta, Egypt</affiliation></author><author><persName><forename type="first">P J</forename><surname>McCluskey</surname></persName><affiliation>Royal Prince Alfred Hospital, Sydney, New South Wales, Australia</affiliation></author><author><persName><forename type="first">H M A</forename><surname>Towler</surname></persName><affiliation>Whipps Cross University Hospital, London, UK</affiliation></author><author><persName><forename type="first">N</forename><surname>Okhravi</surname></persName><affiliation>Moorfields Eye Hospital, London, UK</affiliation></author><author><persName><forename type="first">R P</forename><surname>Singh</surname></persName><affiliation>Royal Prince Alfred Hospital, Sydney, New South Wales, Australia</affiliation></author><author><persName><forename type="first">R</forename><surname>Obikpo</surname></persName><affiliation>Whipps Cross University Hospital, London, UK</affiliation></author><author><persName><forename type="first">S S</forename><surname>Lightman</surname></persName><affiliation>Moorfields Eye Hospital, London, UK</affiliation></author></analytic><monogr><title level="j">British Journal of Ophthalmology</title><title level="j" type="abbrev">Br J Ophthalmol</title><idno type="pISSN">0007-1161</idno><idno type="eISSN">1468-2079</idno><imprint><publisher>BMJ Publishing Group Ltd.</publisher><pubPlace>BMA House, Tavistock Square, London, WC1H 9JR</pubPlace><date type="published" when="2007-07"></date><biblScope unit="volume">91</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="916">916</biblScope></imprint></monogr><idno type="istex">81BEA7A9CAC0F7C8AA51E2570BAC02B0924139B9</idno><idno type="DOI">10.1136/bjo.2006.109660</idno><idno type="href">bjophthalmol-91-916.pdf</idno><idno type="PMID">17229800</idno><idno type="local">0910916</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2007-01-03</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Aims: 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. Method: 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. Results: 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. Conclusion: 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></abstract><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Paediatrics</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Ophthalmologic surgical procedures</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>BCVA, best-corrected visual acuity</term></item><item><term>ERM, epiretinal membrane</term></item><item><term>IOL, intraocular lens</term></item><item><term>IOP, intraocular pressure</term></item><item><term>logMAR, log minimum angle of resolution</term></item><item><term>Nd:YAG, neodymium-doped yttrium aluminium garnet</term></item><item><term>PCO, posterior capsular opacification</term></item><item><term>PMMA, polymethylmethacrylate</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2007-01-03">Created</change><change when="2007-07">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-3-14">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/81BEA7A9CAC0F7C8AA51E2570BAC02B0924139B9/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="other"><front><journal-meta><journal-id journal-id-type="hwp">bjophthalmol</journal-id><journal-id journal-id-type="nlm-ta">Br J Ophthalmol</journal-id><journal-title>British Journal of Ophthalmology</journal-title><abbrev-journal-title abbrev-type="publisher">Br J Ophthalmol</abbrev-journal-title><issn pub-type="ppub">0007-1161</issn><issn pub-type="epub">1468-2079</issn><publisher><publisher-name>BMJ Publishing Group Ltd.</publisher-name><publisher-loc>BMA House, Tavistock Square, London, WC1H 9JR</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="other">0910916</article-id><article-id pub-id-type="doi">10.1136/bjo.2006.109660</article-id><article-id pub-id-type="other">bjophthalmol;91/7/916</article-id><article-id pub-id-type="other">bjophthalmol;bjo.2006.109660</article-id><article-id pub-id-type="pmid">17229800</article-id><article-id pub-id-type="other">916</article-id><article-id pub-id-type="other">bjo.2006.109660</article-id><article-categories><subj-group subj-group-type="heading"><subject>Clinical science</subject><subj-group><subject>Extended reports</subject></subj-group></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Paediatrics</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Ophthalmologic surgical procedures</subject></subj-group></article-categories><title-group><article-title>Outcome of phacoemulsification in patients with uveitis</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Elgohary</surname><given-names>M A</given-names></name><xref rid="AFF1">1</xref><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>McCluskey</surname><given-names>P J</given-names></name><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Towler</surname><given-names>H M A</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Okhravi</surname><given-names>N</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Singh</surname><given-names>R P</given-names></name><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Obikpo</surname><given-names>R</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Lightman</surname><given-names>S S</given-names></name><xref rid="AFF1">1</xref></contrib><aff id="AFF1"><label>1</label>Moorfields Eye Hospital, London, UK</aff><aff id="AFF2"><label>2</label>Tanta University Ophthalmology Hospital, Tanta, Egypt</aff><aff id="AFF3"><label>3</label>Royal Prince Alfred Hospital, Sydney, New South Wales, Australia</aff><aff id="AFF4"><label>4</label>Whipps Cross University Hospital, London, UK</aff></contrib-group><author-notes><corresp>Correspondence to: Professor S S Lightman Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK; <ext-link xlink:href="s.lightman@ucl.ac.uk" ext-link-type="email" xlink:type="simple">s.lightman@ucl.ac.uk</ext-link></corresp></author-notes><pub-date pub-type="ppub"><month>7</month><year>2007</year></pub-date><pub-date pub-type="epub"><day>3</day><month>1</month><year>2007</year></pub-date><volume>91</volume><volume-id pub-id-type="other">91</volume-id><volume-id pub-id-type="other">91</volume-id><issue>7</issue><issue-id pub-id-type="other">bjophthalmol;91/7</issue-id><issue-id pub-id-type="other">7</issue-id><issue-id pub-id-type="other">91/7</issue-id><fpage>916</fpage><history><date date-type="accepted"><day>13</day><month>01</month><year>2007</year></date></history><permissions><copyright-statement>Copyright 2007 British Journal of Ophthalmology</copyright-statement><copyright-year>2007</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bjophthalmol-91-916.pdf"></self-uri><abstract xml:lang="en"><p><bold>Aims:</bold> 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><p><bold>Method:</bold> 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><p><bold>Results:</bold> 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><p><bold>Conclusion:</bold> 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></abstract><kwd-group><kwd>BCVA, best-corrected visual acuity</kwd><kwd>ERM, epiretinal membrane</kwd><kwd>IOL, intraocular lens</kwd><kwd>IOP, intraocular pressure</kwd><kwd>logMAR, log minimum angle of resolution</kwd><kwd>Nd:YAG, neodymium-doped yttrium aluminium garnet</kwd><kwd>PCO, posterior capsular opacification</kwd><kwd>PMMA, polymethylmethacrylate</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Outcome of phacoemulsification in patients with uveitis</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Outcome of phacoemulsification in patients with uveitis</title></titleInfo><name type="personal"><namePart type="given">M A</namePart><namePart type="family">Elgohary</namePart><affiliation>Moorfields Eye Hospital, London, UK</affiliation><affiliation>Tanta University Ophthalmology Hospital, Tanta, Egypt</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P J</namePart><namePart type="family">McCluskey</namePart><affiliation>Royal Prince Alfred Hospital, Sydney, New South Wales, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">H M A</namePart><namePart type="family">Towler</namePart><affiliation>Whipps Cross University Hospital, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">N</namePart><namePart type="family">Okhravi</namePart><affiliation>Moorfields Eye Hospital, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R P</namePart><namePart type="family">Singh</namePart><affiliation>Royal Prince Alfred Hospital, Sydney, New South Wales, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R</namePart><namePart type="family">Obikpo</namePart><affiliation>Whipps Cross University Hospital, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S S</namePart><namePart type="family">Lightman</namePart><affiliation>Moorfields Eye Hospital, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="other" displayLabel="other"></genre><subject><genre>hwp-journal-coll</genre><topic>Paediatrics</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Ophthalmologic surgical procedures</topic></subject><originInfo><publisher>BMJ Publishing Group Ltd.</publisher><place><placeTerm type="text">BMA House, Tavistock Square, London, WC1H 9JR</placeTerm></place><dateIssued encoding="w3cdtf">2007-07</dateIssued><dateCreated encoding="w3cdtf">2007-01-03</dateCreated><copyrightDate encoding="w3cdtf">2007</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Aims: 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. Method: 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. Results: 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. Conclusion: 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.</abstract><note type="author-notes">Correspondence to: Professor S S Lightman Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK; s.lightman@ucl.ac.uk</note><subject><genre>Keywords</genre><topic>BCVA, best-corrected visual acuity</topic><topic>ERM, epiretinal membrane</topic><topic>IOL, intraocular lens</topic><topic>IOP, intraocular pressure</topic><topic>logMAR, log minimum angle of resolution</topic><topic>Nd:YAG, neodymium-doped yttrium aluminium garnet</topic><topic>PCO, posterior capsular opacification</topic><topic>PMMA, polymethylmethacrylate</topic></subject><relatedItem type="host"><titleInfo><title>British Journal of Ophthalmology</title></titleInfo><titleInfo type="abbreviated"><title>Br J Ophthalmol</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0007-1161</identifier><identifier type="eISSN">1468-2079</identifier><identifier type="PublisherID-hwp">bjophthalmol</identifier><identifier type="PublisherID-nlm-ta">Br J Ophthalmol</identifier><part><date>2007</date><detail type="volume"><caption>vol.</caption><number>91</number></detail><detail type="issue"><caption>no.</caption><number>7</number></detail><extent unit="pages"><start>916</start></extent></part></relatedItem><identifier type="istex">81BEA7A9CAC0F7C8AA51E2570BAC02B0924139B9</identifier><identifier type="DOI">10.1136/bjo.2006.109660</identifier><identifier type="href">bjophthalmol-91-916.pdf</identifier><identifier type="PMID">17229800</identifier><identifier type="local">0910916</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright 2007 British Journal of Ophthalmology</accessCondition><recordInfo><recordContentSource>BMJ</recordContentSource></recordInfo></mods></metadata><annexes><json:item><original>true</original><mimetype>image/jpeg</mimetype><extension>jpeg</extension><uri>https://api.istex.fr/document/81BEA7A9CAC0F7C8AA51E2570BAC02B0924139B9/annexes/jpeg</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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