Cataract Surgery in Uveitis: Risk Factors, Outcomes, and Complications.

Purpose: To determine the outcomes of cataract surgery in eyes with uveitis, including the rates of intraoperative and postoperative complications, as well as predictors of visual outcomes.

Design: Retrospective observational cohort study.

Methods: Setting: Tertiary public hospital setting in Auckland, New Zealand, between 2008 and 2020.

Study Population: Patients who underwent cataract surgery following a diagnosis of uveitis.Main observation Procedures: Additional intraoperative procedures, intraoperative and postoperative complications, and postoperative visual outcomes and complications.

Results: 471 eyes of 371 subjects were included. Median duration of uveitis prior to cataract surgery was 3.0 years (interquartile range [IQR] 5.2) and median period of quiescence prior to surgery was 1.0 years (IQR 1.5). Additional procedures (posterior synechiae peel [32.3%] and vision blue [18.1%]) were common. Intraoperative complications occurred in 32 eyes (6.8%). Consultants were the primary surgeons in the majority (82.5%) of operations. By 12 months, visual acuity was 20/50 or better in 248 eyes (79.7%). The most common postoperative complication was uveitis flare, occurring in 56.5%. On Cox proportional hazards analysis, time quiescent was associated with reduced risk of flare (HR 0.794, P = .003). Postoperative cystoid macular edema (CME) developed in 45 eyes (9.6%), with no significant predictors identified on multivariate analysis.

Conclusions: Cataract surgery in uveitis is complex. In the hands of the surgically experienced, rates of intraoperative complications are low. The primary challenge is managing postoperative care as we report a high rate of uveitis relapse and CME. Careful monitoring is important as complications can be unpredictable and occur later than expected.