ArticleJournal of ophthalmic inflammation and infection2025
Management and outcomes of cataract surgery in uveitic eyes with chronic hypotony: a two-case series.
Article in Journal of ophthalmic inflammation and infection, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Clinical practice patterns in uveitic cataract surgery: a national survey.BMC ophthalmology · 2026Article
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2 authors.
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Abstract
backgroundCataract 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.
objectiveTo evaluate the effectiveness of a tailored surgical and immunosuppressive approach for patients with uveitis, cataracts, and chronic hypotony (IOP ≤ 5 mmHg).
methodsA 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.
resultsPreoperative 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.
conclusionA 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.
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