Sutureless Combined 25-Gauge Vitrectomy, Phacoemulsification, and Posterior Chamber Intraocular Lens Implantation for Management of Uveitic Cataract Associated With Posterior Segment Disease

In Brief Purpose: To report visual outcomes and complication rates associated with one-stage surgery for the management of uveitic cataract associated with posterior segment disease. Methods: In this interventional case series, 19 eyes (19 patients) with posterior segment involvement due to chronic uveitis underwent sutureless scleral tunnel incision phacoemulsification combined with total vitrectomy using 25-gauge instruments and posterior chamber intraocular lens (PC-IOL) implantation. Membrane peeling and endolaser photocoagulation were performed when indicated. Outcome measures were visual acuity, inflammatory activity, macular edema, and complications of surgery. Results: After a minimum 12-month follow-up, visual acuity was ≥20/100 in 12 eyes (63.2%); 6 eyes (31.6%) had visual acuity of ≥20/40. A decrease in postoperative inflammatory activity of 1 grade was observed in 8 eyes (42.1%). Sixteen eyes had cystoid macular edema before surgery; and 12 eyes had cystoid macular edema after surgery. Early postoperative complications included the following: transient corneal edema, 10 eyes (50.3%); fibrin reaction, 3 eyes (15.8%), and posterior synechiae, 9 eyes (47.3%). Glaucoma was the most common late postoperative complication (3 eyes [18.8%]). Nine eyes (47.4%) needed YAG laser capsulotomy during the first year. Conclusion: Sutureless combined 25-gauge total vitrectomy, phacoemulsification, and PC-IOL implantation may be well tolerated with an acceptable complication rate for selected uveitic eyes with significant cataract and coexisting posterior segment disease for restoring useful vision. Patients who have uveitis with posterior segment involvement and significant cataracts may benefit from a combined procedure of sutureless scleral tunnel incision phacoemulsification with total vitrectomy using 25-gauge instrumentation and posterior chamber intraocular lens placement. Results for 19 patients (19 eyes) followed for at least 12 months are reported.