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Abstract #99123 Published in IGR 22-4
Outcomes and prognostic factors of cataract surgery in cytomegalovirus related anterior uveitis
Wan KH; Liu K; Lam NM; Chow VWSJournal of Cataract and Refractive Surgery 2022; 48: 1031-1036
PURPOSE: To evaluate the outcomes of cataract surgery in patients with cytomegalovirus (CMV) anterior uveitis and factors associated with final visual outcome. SETTING: A single tertiary academic hospital. DESIGN: Retrospective case series. METHODS: History, clinical characteristics, corrected distance visual acuity (CDVA), medications, and complications of CMV anterior uveitic eyes undergoing cataract surgery between 2010 to 2020 were reviewed. RESULTS: This study included 26 eyes of 26 patients undergoing phacoemulsification. The median duration of disease was 4.8 years and the median quiescent period before surgery was 2.3 years. None required pupil manipulation or had significant intraoperative complications. The median CDVA improved from 20/100 (IQR 20/200-20/50) before surgery to 20/30 (IQR 20/40-20/25) at 1 year and 20/35 (IQR 20/50-20/30) at the last follow-up at a median of 4.9 years after surgery, respectively (p < 0.001). CDVA improved in 19 eyes (73.1%) and was ≥20/40 in 18 eyes (69.2 %). In the multivariate regression model, preoperative use of topical 0.15% ganciclovir (β 0.33, 95% CI 0.17-0.48, p < 0.001) and adjunctive intraoperative intracameral dexamethasone 0.4mg (β 0.19, 95% CI 0.01-0.36, p = 0.043) were associated with a better final CDVA. Loss of CDVA and poor postoperative CDVA visual acuity were mostly attributed to uveitic glaucoma, but preoperative glaucoma or the number of anti-glaucoma medications did not affect final CDVA. CONCLUSION: Cataract surgery in eyes with CMV anterior uveitis was safe and CDVA significantly improved and remained sustained after surgery. Topical ganciclovir 0.15% preoperatively and intracameral corticosteroid intraoperatively appear to maximize the final visual outcome.
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