Outcomes of uveitic cataract and uveitic glaucoma surgery

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Project summary Uveitis is associated with visual impairment and higher incidence of poor outcomes following intraocular surgery—such as cataract surgery or glaucoma surgery. Guidelines proposed to prevent visual impairment and achieve successful surgical outcomes include quiescence of inflammation for atleast 3 months pre-operatively and stringent inflammation control in the perioperative period, however there is limited evidence on which to based practice regarding the real-world outcomes for patients who undergo uveitic cataract surgery and uveitic glaucoma surgery. The Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study is a rich database of uveitis patients (17,907 distinct patients followed over 169,194 visits) with very detailed information on inflammatory status, medications received, surgeries and other outcomes. The database includes over 250 children under the age of 18 who have had uveitic cataract surgery and over 100 children who underwent uveitic glaucoma surgeries, in a field with very sparse literature on pediatric uveitic cataracts and pediatric uveitic glaucoma. Patients who had incisional cataract or glaucoma surgery with at least one visit in the 6 months prior to surgery and at least two post-operative visits beyond 8 weeks postoperatively are included in the analysis. The results from this grant could (1) guide clinicians and patients re: the optimal management of patients in the peri-operative period to achieve best possible visual acuity and intraocular pressure control, (2) explore the incidence of subsequent intraocular surgeries, especially among children, which would impact the planning of surgeries and (3) guide the peri- operative management of patients to prevent intraocular inflammation and subsequently the best visual outcomes. The question of whether to leave a child aphakic or not and whether a trabeculectomy or tube shunt is associated with longer term intraocular pressure control, thus preserving visual function, will have evidence-based guidelines through this analysis. These objectives are responsive to the Strategic Plan and goals of the National Eye Institute, to support applied clinical research concerning blinding eye diseases and preservation of sight, especially the goal “Establish the causes and etiology of uveitis and improve methods for its diagnosis, treatment, and prevention.”