POS0913 UVEAL CATARACT IN PATIENTS WITH SPONDYLOARTHRITIS AND OTHER IMMUNO-INFLAMMATORY DISEASES AND ITS SURGICAL TREATMENT
Authors: S. Avetisov, I. Razumova, K. Avetisov, A. Godzenko
Journal: Annals of the Rheumatic Diseases (2021)

Background: Uveitis is a common extra-skeletal manifestation of various systemic diseases, in particular, spondyloarthritis (SpA). Uveal cataract is the frequent complication of endogenous uveitis. Surgical treatment of uveal cataracts is associated with certain problems, the main being a potential risk of recurrence of uveitis, especially in the case of intraocular lens (IOL) implantation. Objectives: To analyse the results of surgery of complicated uveal cataract in patients with SpA and other rheumatic disorders. Methods: 30 pts (34 eyes) with uveal cataract as a result of systemic immuno-inflammatory diseases were assessed in the “Research Institute of Eye Diseases” in the period from 2006 to 2018. The postoperative follow-up period ranged from 2 to 12 years. 20 pts had different variants of SpA (Group 1):7 (7 eyes) - ankylosing spondylitis, 1 (1 eye) –reactive arthritis, 1 (1 eye) - psoriatic arthritis, 4 (6 eyes) – juvenile spondyloarthritis, 8 (8 eyes) non-radiological SpA. 10 patients (11 eyes) had other systemic diseases (Group 2): 1 (1 eye) Behcet’s disease, 1 (1 eye) - multiple sclerosis, 3 (3 eyes) - Fuchs heterochromic cyclitis, 2 (2 eyes) -cutaneous psoriasis, and 3 (4 eyes) -uveitis of unknown etiology. 4 pts (6 eyes) with juvenile arthritis and pronounced corneal ribbon degeneration were underwent standard intracapsular cryoextraction of the cataract, followed by optical correction of aphakia using spectacle lenses. In other cases, ultrasound phacoemulsification with IOL implantation was used as a surgical aid. All patients had a period of uveitis remission before opreation for at least 2 months.Аnti-inflammatory therapy using local glucocorticoid and local and systemic nonsteroidal antiinflammatory drugs was prescribed 2 weeks before and within a month after the operation. Intra and postoperative complications, fluctuations in intraocular pressure (IOP), improvement of visual acuity, and the frequency of uveitis flares after surgery were assessеd as the main criteria for analyzing the results of surgery. Results: А statistically significant decrease in the number of uveitis exacerbations was observed in all pts: in group 1 - from 2,5 ± 0,65 to 1, 2 ± 0,65 per year (p&lt;0.0001), in group 2 - from 2,55 ± 0,21 to 0,89 ± 0,21 per year (p&lt;0.0001), while there were no statistically significant differences between the groups (p=0.31). Statistically significant increase in maximum visual acuity was observed in all groups: in group 1 - from 0,2± 0,38 to 0,58 ± 0,74, p&lt;0.0001, in group 2 – from 0,24 ± 0,05 to 0,69 ± 0,07, p&lt;0.0001. No complications were observed during operations. The phenomena of bullous keratopathy after intracapsular extraction were noted in 2 pts with juvenile arthritis and ribbon-like corneal degeneration. No рrogression of corneal changes was observed. Opacity in the central zone of the posterior capsule in the period from 2 to 24 months after surgery occurred in 7 cases. In all cases, laser dissection of the posterior lens capsule was performed. Transient increase in IOP in the early postoperative period, normalized by local hypotensive therapy, occurred in 8 cases in groups I. In the long- term follow-up period (2-24 months), persistent IOP decompensation occurred in 6 cases in groups 1 and in 3 cases in groups 2, which required various types of anti-glaucoma operations. Cystic macular edema developed in one case 5 months after surgery as a result of uveitis exacerbation and was stopped by corticosteroid therapy. Conclusion: Surgery of uveal cataracts in pts with SpA and other immuno-inflammatory diseases providing adequate pre- and postoperative аnti-inflammatory therapy improves visual acuity and reduces the frequency of uveitis relapses. Monitoring of IOP is necessary in the postoperative period. References: [1]Mora P., Gonzales S., Ghirardini S. et al. Perioperative prophylaxis to prevent recurrence following cataract surgery in uveitis patients a two-centre, prospective, randomized trial. Acta Ophthalmol. Scandinavica Fondation. 2016 Sept.; 94(6): e 390-394. http//doi. 10.1111/aos.12955. Epub 2016 Feb 5. Disclosure of Interests: None declared