Journal of ophthalmic inflammation and infection · 2025
Management and outcomes of cataract surgery in uveitic eyes with chronic hypotony: a two-case series.
СтатьяНазвание и аннотация: Перевод в очереди
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Alhaimi Fawzia, Bakhamees Walaa
Аннотация
BACKGROUND: Cataract surgery in uveitic eyes with persistent hypotony is considered high-risk and is often deferred. This report describes the perioperative management and visual outcomes in such complex cases.
OBJECTIVE: To evaluate the effectiveness of a tailored surgical and immunosuppressive approach for patients with uveitis, cataracts, and chronic hypotony (IOP ≤ 5 mmHg).
METHODS: A retrospective review of two cases: a 21-year-old female with chronic intermediate non-granulomatous uveitis and a 17-year-old male with Vogt-Koyanagi-Harada (VKH) disease. Both developed bilateral cataracts and persistent hypotony. A multi-step protocol was implemented, involving aggressive immunosuppression (azathioprine/methotrexate plus adalimumab) and an average of two periocular triamcinolone acetonide (40 mg/mL) injections per eye to elevate IOP to a safe surgical threshold (≥ 8 mmHg). After achieving ≥ 3 months of quiescent inflammation and normalized IOP, patients underwent lens aspiration with intravitreal triamcinolone injection and were intentionally left aphakic.
RESULTS: Preoperative IOP was successfully elevated to a mean of 10 mmHg. One eye experienced an intraoperative complication (dropped nucleus) requiring pars plana vitrectomy; this eye later developed corneal decompensation necessitating penetrating keratoplasty. Postoperative inflammation resolved within one week in all eyes. On long-term follow-up (mean 24 months), inflammation remained controlled on maintenance immunosuppression. At the two-year follow-up, best-corrected visual acuity was 20/30 in three eyes and 20/50 in the eye that required additional surgeries. IOP was maintained at ≥ 8 mmHg in all eyes.
CONCLUSION: A meticulously planned, multi-modal approach-involving aggressive control of inflammation, targeted reversal of hypotony with periocular steroids, and strategic surgical timing with intentional aphakia-can lead to successful anatomical and visual outcomes in high-risk uveitic patients with cataracts and persistent hypotony.
OBJECTIVE: To evaluate the effectiveness of a tailored surgical and immunosuppressive approach for patients with uveitis, cataracts, and chronic hypotony (IOP ≤ 5 mmHg).
METHODS: A retrospective review of two cases: a 21-year-old female with chronic intermediate non-granulomatous uveitis and a 17-year-old male with Vogt-Koyanagi-Harada (VKH) disease. Both developed bilateral cataracts and persistent hypotony. A multi-step protocol was implemented, involving aggressive immunosuppression (azathioprine/methotrexate plus adalimumab) and an average of two periocular triamcinolone acetonide (40 mg/mL) injections per eye to elevate IOP to a safe surgical threshold (≥ 8 mmHg). After achieving ≥ 3 months of quiescent inflammation and normalized IOP, patients underwent lens aspiration with intravitreal triamcinolone injection and were intentionally left aphakic.
RESULTS: Preoperative IOP was successfully elevated to a mean of 10 mmHg. One eye experienced an intraoperative complication (dropped nucleus) requiring pars plana vitrectomy; this eye later developed corneal decompensation necessitating penetrating keratoplasty. Postoperative inflammation resolved within one week in all eyes. On long-term follow-up (mean 24 months), inflammation remained controlled on maintenance immunosuppression. At the two-year follow-up, best-corrected visual acuity was 20/30 in three eyes and 20/50 in the eye that required additional surgeries. IOP was maintained at ≥ 8 mmHg in all eyes.
CONCLUSION: A meticulously planned, multi-modal approach-involving aggressive control of inflammation, targeted reversal of hypotony with periocular steroids, and strategic surgical timing with intentional aphakia-can lead to successful anatomical and visual outcomes in high-risk uveitic patients with cataracts and persistent hypotony.