|Year : 1982 | Volume
| Issue : 2 | Page : 87-89
Surgical treatment of complicated cataract following chronic uveitis
P Namperumalsamy, Taraprasad Das
Aravind Eye Hospital, Madurai, Tamilnadu, India
Aravind Eye Hospital, Madurai, Tamilnadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Namperumalsamy P, Das T. Surgical treatment of complicated cataract following chronic uveitis. Indian J Ophthalmol 1982;30:87-9
|How to cite this URL:|
Namperumalsamy P, Das T. Surgical treatment of complicated cataract following chronic uveitis. Indian J Ophthalmol [serial online] 1982 [cited 2020 Nov 23];30:87-9. Available from: https://www.ijo.in/text.asp?1982/30/2/87/28084
The common sequelae of recurrent a complicated cataract often associated with a low intraocular tension, cyclitic membrane, treous opacities, traction retinal detachment and cystoid macular oedema. A sense of uncertainty always surrounds the surgical management of the complicated cataract associated with chronic uveitis. The conventional procedures like extracapsular cataract extraction is liable to excite inflammatory reaction and result in dense pupillary membrane. Moreover, it does not take care o the vitreous opacities and other associated complications.
The pars plana lensectomy and vitrectomy[,3] or conventional intracapsular cataract extraction with pars plana vitrectomy offers a new surgical pathway to tackle such problems.
| Materials and methods|| |
At Aravind Eye Hospital four cases of chronic uveitis with complicated cataract have been treated by pars plana surgery. All of them had variable duration of uveitis, minimum being of nine months and maximum of two years. They had adequate medical treatment with local and systemic steroids, antituberculous drugs, etc. The uveitis was not active and complicated cataract was the cause of defective vision. All of them were subjected to careful preoperative examination of vision, intraocular tension and slitlamp biomicroscopy.
Both lensectomy and vitrectomy were done through pars plana approach through a 3 mm to 3.5 mm sclerotomy incision 4.5 mms. away and parallel to the limbus at 10.30 0' clock meridian. Peyman's vitreophage was used in all cases.
When cataract extraction was planned with vitrectomy, the sclerotomy wound was made and kept ready; cryo extraction of the cataract was done through a 160' limbal section. This was closed with ten interrupted 9'o silk corneo-scleral sutures and then vitrectomy was performed through the previously made sclerotomy wound.
In all the cases total vitrectomy was done.
| Observations|| |
In all four eyes the disease is controlled with no fresh keratic precipitates or aqueous flare in slit lamp examination. In the fourth case vitreous became hazy again four weeks following surgery, but was controlled with oral Prednisol 30 mg. per day in tapering doses. Visual improvement with aphakic correction in the first and fourth case is from perception of light to 6/24 and 6/36 respectively and in the third, from counting fingers at half meter to 6/24. The second case who had a very low intraocular tension and defective projection did not improve due to traction retinal detachment detected after lensectomy. The period of follow up is one year each in the first three cases and six months in the last. [Table - 1].
| Discussion|| |
Conventional cataract surgery for complicated cataract secondary to chronic uveitis is confronted with many complications, such as recurrent inflammation, pupillary membrane, glaucoma, etc. Recently phacoemulsification and pars plana lensectomy have been employed in such cases. Though our experience is limited to four patients, it indicates that these patients are benefited from this type of surgery.
Three out of our four patients showed marked improvement in visual acuity though, no one improved beyond 6/24 inspite of media being clear and cessation of signs of uveitis. This could be due to existing cystoid macular oedema as a part of the uveitic disease process, as has been reported by Diamond et al. But it is hard to determine its existence before surgery in presence of the cataract.
In one of our cases the preoperative intraocular tension was too low and the eye was pre-phthisical. It is rather difficult to perform conventional cataract surgery in such soft eyes, which is why pars plan a surgery is all the more essential.
The follow-up period is short and it may be too early to come to a conclusion whether the disease process will recur or not in future. But at present three of our patients are enjoying useful good vision. Diamond et all are of the opinion that mechanical removal and debridement of the vitreous framework in association with the lens, facilitates the removal of the cellular material from the vitreous cavity i.e. large number of inflammatory cells in the vitreous cavity and the persistent immune complexes are mechanically reduced and contributes to the beneficial effect in such cases.
However, we still believe that pre-operative and post-operative systemic steroids for four weeks should be used to minimise the risk of recurrence.
| Summary|| |
Pars plana vitrectomy and lens removal by pars plana approach or conventional approach were ti ied in four cases of complicated cataract secondary to chronic uveitis. The visual acuity improved in three of them with no recurrence of the disease.
| References|| |
Diamond, J G. and Kaplan, H.J., 1978, Arch. Ophthalmol. 96: 1798.
Michels, R.G. and Ryan, S J., 1975, Amer. J. Ophthalmol. 80: 24.
Peyman, G.A., Humonte, F. and Goldberg, M.F., 1975, Amer J. Ophthalmol. 80 . 32.
Ridley, H., 1965, Trans. Ophthalmol. Soc., U.K. 85 : 519
[Table - 1]