Uveitis surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]

Surgery

There are several surgical options for treatment of uveitis based on following indications:

• Indications:
  • Therapeutic i.e visual rehabilitation: Surgery for removal of cataract, band keratopathy, corneal scars, pupillary membranes, removal of dense vitreous membranes.
  • Diagnostic: aqueous tap, vitroeus biopsy, tissue biopsy
  • Management of complications: Surgery for glaucoma, vitreous hemorrhage, retinal detachment and chronic hypotony.

Surgical options for Visual Rehabilitation

Indications for cataract surgery

• Phaco-antigenic uveitis: leakage of lens protein resulting in inflammation
• Cataract impairing vision
• Cataract impairing posterior segment visualisation: cases of retinal neovascularisation, retino-choroidal pathology or patient undergoing vitreo-retinal

surgery.

Surgical options for cataract surgery

• Phacoemulsification
• Extracapsular cataract extraction
• Posterior chamber intraocular lens implantation

Indications for surgery in Band shaped Keratopathy

• Juvenile idiopathic amblyopia

Surgical options in Band Shaped Keratopathy

• Phototherapeutic keratectomy
• Chemical chelation with EDTA
• Superficial keratectomy with or without adjuvent amniotic membrane transplant

Diagnostic Vitrectomy

Indications for diagnostic vitrectomy

• Atypical clinical presentation
• Failure to response to treatment
• Strong suspicion of malignancy
• Rapidly progressive disease with inconclusive work up

Methods used for Diagnostic Vitrectomy

• Vitreous tap
• Vitreous biopsy
• Chorioretinal biopsy

Surgical management of complications of Uveitis

Glaucoma

Indications for Uveitic Glaucoma surgery

• Glaucoma resistant to medical treatment
• Acute angle closure Glaucoma

Surgical options

• Glaucoma drainage implant if there is active inflammation
• Trabeculectomy with antiproliferative agent in cases of uncontrolled IOP
• Laser peripheral Iridotomy in cases of angle closure of glauco