[Clinical research of anterior chamber inflammation after phacoemulsification surgery in patients with complicated cataract secondary to uveitis].

ABSTRACT

OBJECTIVE: To investigate anterior chamber inflammation after phacoemulsification with intraocular lens (IOL) implantation in patients with Vogt-Koyanagi-Harada (VKH) syndrome or Behçet's disease (BD). METHODS: Cohort study. Seventeen patients (20 eyes) with complicated cataracts and VKH syndrome or BD who underwent phacoemulsification with IOL implantation at Zhongshan Ophthalmic Center, Sun Yat-Sen University (SYSU) between January 2010 and June 2011 were included as the experimental group in this study. Cataract surgery was performed on these patients only when uveitis had been under control for more than three months. Thirty patients (40 eyes) with age-related cataracts who underwent phacoemulsification with IOL implantation in the same period were included as the control group. Quantitative measurements of anterior chamber aqueous flare and inflammatory cells were conducted preoperatively and postoperatively using a Laser Flare Cell Meter (LFCM). Independent t-test was used to compare patients' ages, and the energy and time of phacoemulsification between the two groups. The Student's t-test was used to assess the differences between paired data preoperatively and postoperatively. Independent t-test was also used to assess the quantitative data between groups. RESULTS: The study recruited 20 eyes in the experimental group and 40 eyes in the control group, including 11 eyes from 9 VKH patients and 9 eyes from 8 BD patients. The preoperative and postoperative flare values in the experimental group were (19.86 ± 6.47), (44.28 ± 18.47), (35.60 ± 12.65), (23.85 ± 8.41), and (13.86 ± 4.27) pc/ms, respectively, which were statistically higher than that of the control group preoperatively, and on days 1, 7, 30, and 90 after surgery (tpre = 4.643, Ppre < 0.01; t1 = 6.035, P1 < 0.01; t7 = 3.595, P7 = 0.001; t30 = 4.658, P30 < 0.01; t90 = 3.308, P90 = 0.002). Aqueous flare in Group A and Group B declined to preoperative levels on day 30 (t = 0.320, P = 0.753) and day 7 (t = 0.454, P = 0.653). For the experimental group, the inflammatory cell count on day 1 and 7 was (83.46 ± 27.08) and (27.56 ± 8.32) cells/0.5 mm(3), respectively, which was significantly higher than the preoperative level [(6.47 ± 3.56)cells/ 0.5 mm(3), t1 = 5.261, P1 < 0.01; t7 = 2.766, P7 = 0.012]. On days 30 and 90, the inflammatory cell count was (11.43 ± 4.81) and (4.82 ± 2.29) cells/0.5 mm(3), respectively, and there was no statistically significant difference in the inflammatory cell count compared with the preoperative level (t30 = 2.348, P30 = 0.042; t90 = 1.376, P90 = 0.186). For the control group, inflammatory cell count reduced to pre-operative level on day 7 (t7 = 2.464, P7 = 0.018). CONCLUSIONS: Anterior chamber inflammation reaches peak levels one week postoperatively in VKH and BD patients who receive phacoemulsification with IOL implantation. It takes three months for the inflammation to recede, and might take longer for complete restoration of the blood-aqueous barrier.