Cataract Surgery in Ocular inflammation

What is Cataract Surgery in People with Ocular Inflammation?

Ocular inflammation is the inflammation of eye tissue layers. Uveitis is the most common form of ocular inflammation. The condition results in the inflammation of the middle layer of the eye (uvea) causing swelling and destruction of eye tissues. Uveitis can also affect the vitreous, optic nerve, retina, and lens, producing decreased vision or severe vision loss.

A cataract is a condition which causes clouding of the natural lens in the eye, resulting in blurry vision. The lens is mostly made up of water and proteins. These specific proteins provide the lens its transparent structure. Any structural change in these proteins can alter the clarity of the lens and negatively impact vision. Vision can be corrected with cataract surgery, which involves the removal of the cloudy lens and replacing it with an artificial intraocular lens (IOL) implant to restore normal vision.

Cataract is one of the most common complications of uveitis and occurs from chronic intraocular inflammation and corticosteroids used for the treatment of this condition. Occurrence of a cataract in an eye with a history of recurrent or chronic uveitis is known as cataracta complicata. These cataracts pose various challenges to the surgeon at every stride. Complications start from the preoperative management of inflammation to intraoperative issues such as inferior visibility due to small pupils, band keratopathy, pupillary membranes, posterior synechiae, unusual anterior capsules, and bleeding from abnormal iris vessels. The postoperative course can be complicated by cystoid macular oedema, recurrence of inflammation, and posterior capsular opacification. Despite all these complications, present-day surgical techniques, improvement in instrumentation, sensible use of immunomodulatory therapy in the management of inflammation, and the latest technologies in the development of intraocular lenses (IOL) have aided in enhancing the visual result in people with cataracta complicata.

Indications of Cataract Surgery in People with Ocular Inflammation

Some of the common indications of cataract surgery in people with ocular inflammation/uveitis include:

Cataract that conceals sufficient visualization of the posterior eye segment
Cataract that hinders the evaluation of the fundus
Significant cataract with controllable preoperative inflammation and scope to improvement in visual acuity post cataract surgery
Phacoantigenic uveitis, a condition in which removal of the cataract is mandatory

Preoperative Evaluation and Planning

A pertinent history, detailed systemic and ophthalmic assessment, and review of medical systems together with laboratory testing usually indicate the aetiology of uveitis. When planning cataract surgery, it is crucial to maintain the uveitis under control and a quiet eye before surgery, meaning the anterior chamber must be free from cells. Often, it is almost impossible to have total resolution of the flare, hence a minor level of baseline flare is acceptable.

In order to achieve strict preoperative control of inflammation and to reduce postoperative inflammatory response, patients are started on topical steroids and nonsteroidal anti-inflammatory drugs for specified days prior to cataract surgery. The use of immunosuppressive drugs or systemic steroids may sometimes be considered cases of aggressive forms of uveitis.

Preparation for Cataract Surgery in People with Ocular Inflammation

Preoperative preparation prior to cataract surgery in people with ocular inflammation may involve the following:

A complete eye examination to evaluate the overall health of your eyes and to study the shape and features of the eye in general
A refraction test to determine the degree of farsightedness, nearsightedness, and/or astigmatism
A measurement of the curvature of the pupils and cornea as well as the thickness of the cornea
A discussion about any medications or supplements you may be taking as some can complicate your cataract surgery
Avoiding wearing any eye makeup or face cream
Arranging for someone to drive you home after surgery
Signing an informed consent form after discussing the pros and cons of the procedure in detail with you

Procedure for Cataract Surgery in People with Ocular Inflammation

The surgical procedure for cataract removal and IOL implantation is typically performed in an outpatient setting and does not need an overnight stay in a hospital or clinic facility.

There are three main types of cataract surgery: phacoemulsification, extracapsular cataract surgery, and intracapsular cataract surgery. Phacoemulsification is the most common and preferred technique used in cataract surgery and involves the following steps:

Your surgeon will first numb your eye with anaesthetic eye drops.
An eyelid holder will be placed on your eye to prevent the eye from blinking.
A small incision is made through your cornea using an operating microscope to access the lens.
A high-frequency ultrasound device is used to break up the cloudy natural lens into tiny pieces for easier removal.
Suction is used to gently remove the broken cloudy lens pieces from the eye.
A clear intraocular lens is carefully inserted behind the iris and pupil in the same place your natural lens had occupied.
The incision is then closed, and a protective shield is placed over the eye to complete the operation.

Postoperative Care Instructions and Recovery

In general, postoperative care instructions and recovery after cataract surgery in people with ocular inflammation may involve the following:

You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs as you recover.
You will be prescribed medicated eye drops to be used several times a day for a week to prevent infection and inflammation.
You should wear a protective eye shield for at least a week at night or while napping to prevent accidental rubbing of your eyes while asleep.
You should wear sunglasses to protect your eyes while outdoors.
Avoid strenuous activities and heavy lifting for a week so that there is no stress on the eye as it heals.
Keep away from dusty environments and avoid splashing water into your eyes for a week to reduce the risk of irritation and infection.
Avoid hot tubs or swimming and close your eyes while bathing or showering for a week.
Do not drive until cleared by your ophthalmologist.
A follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Cataract surgery and intraocular lens implantation is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

Bleeding
Infection
Redness
Swelling
Retinal detachment
Displacement of the intraocular lens implant
Cystoid macular oedema
Persistent inflammation
Posterior synechiae
Posterior capsular opacification