Clinical Facts and recommendations when Phacoemulsification is scheduled on Uveitic patients
✍ never operate angry eye ( unless phacolytic or Phacoanaphylactic )
✍ eye must be quiet 蘿 for 3 months at least except in previously mentioned situation should receive immediate surgery
✍ Prophylactic iridectomy is recommended to prevent presumed pupillary block from synechia
✍ IOL implantation for Phacoemulsification in Uveitic patients :
Heparin coated or acrylic IOL is used ( bag implantation)
one piece or 3 pieces is ok
Avoid the plate- haptic IOL as it has risk of dropping and slipping into the vitreous after YAG laser capsulotomy ( if needed)
Avoid mutlifocal IOL as the pupil is not regular and there is high risk of decentration due to inflammation with intolerable image blurt and glare
Avoid Silicon IOL as possible specially if there is retinal pathology with subsequent presumed retinal surgery
✍ Meticulously removal of any cortex
✍ Avoid touching angry iris
✍ Consider IOL explanation (if postoperative Endo or chronic persistent Uveitis)
✍ Pre and post operative frequent topical steroid is highly recommended with gradual tapering
✍ Consider using topical NSAIDs for 2 months after the 1st postoperative week to prevent pseudophakic CME ( high risk)
✍ Look for PCO sooner phacoemulsication in Uveitic patients:
Posterior capsular opacification (PCO) occurs earlier in uveitic eyes
Nd:YAG laser capsulotomy may need to be performed sooner after surgery in symptomatic patients
the capsulotomy should be deferred if the uveitis is still active or if there is CME.
✍ Anatomical challenges to be expected to face with proper managing phacoemulsication in Uveitic patients:
Narrow pupil
floppy iris
Severe synechia
weak zonules
Bad view under the surgical microscope ( bad cornea or cyclitic membrane)
✍ Compined Phaco-trab is an option in if patient is strong steroid responder and can’t tolerate long term steroids therapy.
Relatively contraindicated to IOL implant ( debatable issue) in Juvenile idiopathic arthritis in young patient, due to persistent chronic postoperative Uveitis with cyclitic membrane formation with subsequent phthisis bulbi
young children are the only uveitis patients who are often left aphakic after cataract removal to allow development of the eye and the visual system before an IOL is implanted, which usually takes place when the child reaches school age.
Until then, any refractive error is corrected with ultra-soft extended-wear contact lenses (or, in bilateral cases, with aphakic spectacles)
When it’s time for an IOL, primary posterior capsulotomy should be performed when the IOL is implanted. PCO is common in young children, and a secondary Nd:YAG capsulotomy would expose them to the risks of general anesthesia again ( if not cooperative)
Some surgeons prefer to use a 3 pieces IOL in this situation, leaving the haptics in the capsular bag and capturing the optic posterior to the capsular opening.
