Recurrent uveitis after phacoemulsification

Aim: To evaluate the cases of recurrent post operative uveitis after phacoemulsification. Introduction: Post operative uveitis is a common finding after intra-ocular surgery and respond well to corticosteroids. After phacoemulsification the trend is changing and many cases with recurrent inflammation are specific with phacoemulsification which respond well to steroidal therapy and in most cases invasive intervention are not required. In this study we have seen twelve cases of phacoemulsification associated with recurrent attacks of anterior uveitis after completing routine course of medication post operatively. Materials and Methods: This is a retrospective study of 565 cases of uncomplicated cataract (212 SICS + 353 Phacoemulsification) surgery done by a single surgeon in a period of two years between April 2014 to March 2016. All the patients did well during 6 weeks of routine treatment. But 12 patients after completing topical steroid course developed symptoms like decreased vision, photophobia, redness and pain of mild to moderate degree. Slit lamp examination showed mild to moderate circum ciliary congestion with aqueous cell +1 to +3 with some flare and few fine keratic precipitates in some cases. Systemic evaluation was done in all the cases to find out any systemic association with uveitis. Result: All (12 cases) were started with topical corticosteroid 4 times to one hourly depending on grade of uveitis and tapered in next 4-6 weeks. Supportive cycloplegics were given till cells were present in anterior chamber. No oral corticosteroids were given in first attack of uveitis. 6 cases recovered well with this treatment regime. Six cases had recurrent attacks and were given repeat dose of topical steroids and cycloplegic along with oral prednisolone 1mg/kg in weekly tapering doses. 5 cases responded well to single course of oral steroid while one had to give twice full course of oral steroids along with 4 course of topical steroids. Conclusion: Various causes like cortical matter in AC, residual viscoelastic or metallic dust may cause recurrent uveitis after cataract surgery. But Metallic dust as a cause is specific to phacoemulsification procedure and may be the main culprit for recurrent inflammation in this study. Our study suggest that chronic recurrent cases of anterior uveitis after phaco-emulsification of mild to severe severity can be safely treated by topical and if needed by adding oral steroid without invasive interventions.