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

To report the visual outcomes and complication of one-stage surgery for management of uveitic cataracts associated with posterior segment disease. In this retrospective interventional case series, 19 eyes of 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 (PCIOL) implantation. Membrane peeling and endolaser photocoagulation were performed when indicated. Outcome measures were visual acuity, inflammatory activity, macular edema and surgical complications. After a minimum 12-month follow-up, visual acuity was >20/100 in 12 eyes (63.2%) and >20/40 in 6 eyes (31.6%). One grade of decrease in postoperative inflammatory activity was observed in 8 eyes (42.1%). Cystoid macular edema was present in 16 eyes preoperatively and in 12 eyes postoperatively. Early postoperative complications included transient corneal edema in 10 eyes (50.3%), posterior synechia in 9 eyes (47.3%) and fibrin reaction in 3 eyes (15.8%). Glaucoma was the most common late postoperative complication (3 eyes, 18.8%). Nine eyes (47.4%) needed YAG laser capsulotomy during the first year. Combined sutureless 25-gauge vitrectomy, phacoemulsification, and PCIOL implantation may be a well tolerated procedure with an acceptable complication rate for visual restoration in selected uveitic eyes with significant cataract and coexisting posterior segment disease.