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]

Overview

Surgical management of uveitis is ususally reserved for patients with complications of uveitis or in cases where patient fails to respond to medical treatment.

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 glaucoma

retinal detachment

Several types of Vitreo-retinal surgeries are required for various types of retinal detachment resulting as a complications of uveitis.