Clinical practice patterns in uveitic cataract surgery: a national survey.

BACKGROUND

Cataract is a frequent and visually significant complication of uveitis, yet perioperative management practices vary widely and are not always guided by standardized protocols, particularly in settings such as Pakistan where uveitis is relatively common. This study aimed to describe current perioperative management practices for uveitic cataract among ophthalmologists in Pakistan, providing an observational baseline to inform future evidence-based consensus rather than prescribing clinical recommendations, and to explore variations based on clinician experience and case volume.

METHODS

This descriptive cross-sectional survey included fellowship-trained ophthalmologists in Pakistan actively managing uveitic cataract. A structured, expert-validated questionnaire assessed perioperative inflammation control, intraoperative strategies, postoperative regimens, clinical decision-making, and attitudes toward national guidelines. The survey was administered electronically from December 2025 to February 2026. Responses were stratified by clinical experience and annual case volume, and statistical analysis was performed using chi-square and Fisher's exact tests.

RESULTS

Fifty-one ophthalmologists responded (51% response rate); 68.6% had ≤ 10 years of post-fellowship experience. A quiescent period of ≥ 3 months was the most common determinant of surgical timing (72.5%). Preoperatively, intensified topical corticosteroids were widely used (72.5%), and nearly half prescribed short systemic steroids (49.0%). Combined pharmacologic-mechanical strategies were preferred intraoperatively (74.5%), and 80.4% routinely implanted a primary IOL when capsular support was adequate, most commonly hydrophobic acrylic (49.0%). Postoperatively, 62.7% used systemic steroids routinely in all cases, and 47.1% routinely prescribed topical NSAIDs for cystoid macular edema prophylaxis. Preoperative macular integrity on OCT was most often identified as the strongest predictor of visual gain (45.1%). Significant differences in steroid intensification and NSAID use were observed according to surgeon experience (p < 0.05). Overall, 84.3% supported development of national standardized guidelines.

CONCLUSION

Among surveyed Pakistani ophthalmologists, significant variability exists in perioperative management of uveitic cataract surgery, influenced by surgeon experience and annual case volume. These findings offer a regional baseline; standardized national guidelines, informed by broader consensus-building, may improve consistency and outcomes in this complex patient population.