Extração da catarata pela técnica de facoemulsificação em pacientes com uveíte / Cataract extraction using the phacoemulsification technique in patients with uveitis

OBJETIVO: Descrever os resultados da cirurgia de catarata pela técnica de facoemulsificação em pacientes com uveíte. MÉTODOS: Foi realizado estudo retrospectivo pela análise de prontuários de 189 pacientes (242 olhos) com uveíte que foram submetidos a cirurgia de catarata pela técnica de facoemulsificação no Setor de Uveítes e Imunologia Ocular do Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canadá. Os dados foram coletados em fichas protocoladas com informações sobre sexo, idade, classificação da uveíte, descrição cirúrgica e exames pré e pós-operatórios. Os exames pré e pós-operatórios continham informações sobre a data do exame, a melhor acuidade visual corrigida, o exame biomicroscópico, a pressão intra-ocular, os procedimentos realizados e o tratamento em uso. RESULTADOS: A média de acompanhamento pós-operatório foi de 46,8 ± 31,2 meses. A média da acuidade visual pré-operatória encontrada foi de 20/100 e a média de acuidade visual pós-operatória encontrada foi de 20/40. Encontramos 145 olhos (59,5 por cento) com acuidade visual melhor ou igual a 20/40 e 26 olhos com piora da acuidade visual. A complicação per-operatória mais encontrada foi a ruptura de cápsula posterior com perda vítrea observada em 7 olhos (3 por cento do total de olhos). A recorrência da uveíte foi a complicação pós-operatória mais freqüente, sendo observada em 73 olhos (30,16 por cento). Outras complicações pós-operatórias observadas foram a atrofia iriana (28,51 por cento), hipertensão intra-ocular (28,09 por cento), membrana epirretiniana (26,44 por cento), opacidade de cápsula posterior (19 por cento), edema macular cistóide (13,63 por cento), hipotonia ocular (12,80 por cento), atrofia do disco óptico (8,67 por cento) e sinéquias posteriores (6,61 por cento). CONCLUSÕES: A cirurgia de catarata pela técnica de facoemulsificação é considerada segura e eficaz em pacientes com uveíte. Observamos um bom prognóstico visual no período...

PURPOSE: To report outcomes of cataract extraction by phacoemulsification in patients with uveitis. METHODS: We retrospectively reviewed the charts of 189 patients (242 eyes) with uveitis who underwent cataract extraction by phacoemulsification at the Uveitis and Ocular Immunology Unit of McGill University Health Centre, Montreal, Quebec, Canada. RESULTS: Average follow-up was 46 ± 31.2 months. Average preoperative visual acuity was 20/100 and average postoperative visual acuity was 20/40. Hundred and forty-six eyes (59.9 percent) attained visual acuity better than 20/40. Visual loss occurred in 26 eyes. The most common peroperative complication was posterior capsule rupture with vitreous loss seen in 7 eyes (3 percent). Recurrence of uveitis was the most common postoperative complication seen in 73 eyes (30.16 percent). Other postoperative complications included iris atrophy (28.51 percent), ocular hypertension (28.09 percent), epiretinal membrane (26.44 percent), posterior capsule opacification (19 percent), cystoid macular edema (13.63 percent), ocular hypotony (12.80 percent), optic disc atrophy (8.67 percent) and posterior synechiae (6.61 percent). CONCLUSIONS: Cataract extraction by phacoemulsification is safe in patients with uveitis. Successful visual results are observed in long-term follow-up despite the prevalence of recurrence of uveitis, posterior capsule opacification and macular abnormalities. To the best of our knowledge this is the largest series presented to date.

Herpes simplex uveitis

BACKGROUND: Uveitis in herpes simplex virus (HSV) ocular disease is usually associated with corneal stromal disease. It has generally been believed that herpetic uveitis in the absence of corneal disease is very rare. When seen it is usually attributed to varicella zoster virus (VZV) infections. The diagnosis of uveitis caused by herpes simplex is often not diagnosed resulting in inadequate treatment and a poor visual result. METHODS: Seven patients from a large uveitis practice who presented with a clinical picture of: anterior uveitis and sectoral iris atrophy without keratitis, a syndrome highly suggestive of herpetic infection, are reported. Polymerase chain reaction (PCR) was done in the aqueous of four of them and was positive for HSV. One patient had bilateral disease. Most of the patients also had severe secondary glaucoma. RESULTS: Of the seven patients presented five had no history of any previous corneal disease. Two had a history of previous dendritic keratitis which was not active at the time of uveitis development. One patient with bilateral disease was immunosuppressed at the time when the uveitis developed. Six of the seven patients had elevated intraocular pressures at the time of uveitis and five required glaucoma surgery. Intractable glaucoma developed in two patients leading to rapid and severe visual loss despite aggressive management. CONCLUSION: Findings suggest that uveitis without corneal involvement may be a more frequent manifestation of ocular herpes simplex disease than previously thought. Absence of corneal involvement delays a correct diagnosis and may worsen visual outcome. Primary herpetic uveitis (when there is no history of previous corneal disease) seems to be more severe than the uveitis in patients with previous corneal recurrences. The associated glaucoma may be a devastating complication