Download Uveitis

Postoperative uveitis
Ahmad Jahanbakhshi, MD
TASS
Chronic
Endophthalm
itis
Preexisiting
Uveitis
Diabetic
patients
UGH
• TASS: acute inflammatory reaction ,noninfectious substance enters AC
,toxic damage to intraocular tissues, within 12-48 h after uncomplicated
surgery,mimics infectious endophthalmitis.
1.Minimal or no pain
2- pronounced cellular and fibrinous
AC reaction
3.diffuse limbus-to-limbus corneal
edema without posterior segment
involvement.
Clinical feature
It usually improves with local
steroid but may result in
chronic elevation of IOP or
irreversible corneal edema (J
Fr Ophtalmol. 2015 )
AC inflammation is severe with
hypopyon, No bacterium in ocular
samples.
Initialy infectious and noninfectious
inflammation indistinguishable ,TASS
is usually diagnosed and treated as
acute endophthalmitis.
Etiology:For a few of these outbreaks, the inciting factors were identified, but for
the majority, the precipitating factors were often postulated but not confirmed.
anesthetics and
antibiotics
i
Incorrectly BSS,
pH,or osmolarity
• Bacterial
endotoxin
preservatives,
•
hand gloves,
• IOL,medicati
ons/solutions,
• Denatured
OVD
Viscoelastic
substance( Ivisc®1.4% sodium
hyaluronate(Cutan
Ocul Toxicol. 2015
Outbreak of Late-Onset Toxic Anterior Segment Syndrome After
Implantation of One-Piece IOL. (Am J Ophthalmol. 2015 Jul)
Two cases of toxic anterior segment syndrome from
generic trypan blue(J Cataract Refract Surg. 2015 )
Some cases of TASS associated with spillover of subconj
gentamicin at the end of routine cataract surgery have
been reported
It is important to recognize that contamination of OVDs with endotoxins
can occur at the time of manufacturing. Therefore, i.e. <0.5 endotoxin
units/ml must be considered during OVD manufacture.
• 6 case,fulminant onset,first 24
h of surgery,high IOP, corneal
edema similar to TASS,corneal
infiltrates, scleral and uveal
necrosis ,hyphema, brownish
exudates in AC,necrotizing
retinitis in despite immediate
intravitreal AB and
vitrectomy.gram-positive bacilli
in aqueous.2 eyes required
therapeutic keratoplasty,with a
scleral patch graft in 1 eye, 1
eye was eviscerated after 48,
and 2 eyes had phthisical
changes within 10 days .
One must closely observe
every case of TASS that
presents with intense pain
and extremely high IOP
and rule out APE owing to
B cereus with microbiologic
testing.(Ophthalmology. 2015 )
final coarse of TASS:
 resolution of severe iridocyclitis was 4 to
8 days
 24% atrophic iris changes,
 4% CME,
 12.5% anterior capsule phimosis
 16% PCO.
>>
There was no significant difference
between the mean BCVA at 1 month and 6
months.
TASS responded to intensive topical anti
inflammatory medication, and was usually
associated with a good visual outcome. (J
Cataract Refract Surg. 2016)
Uveitis
Mean
relapse-free
time was
similar (131150 days
group A
(topical
steroid)
group B
(topical +
oral steroid)
Perioperative prophylaxis to prevent recurrence following
cataract surgery in uveitic patients (Acta Ophthalmol. 2016
Feb )
Uveitis and IVTA
BCVA
improvement
>2 lines in
86.7%.
BCVA >1/10
in 73%
(4 mg)
17%
BCVA=
5/10
Intraoperative intravitreal triamcinolone acetonide for
cataract extraction in patients with uveitis controlled
postoperative inflammation in all eyes at least 3 months
following surgery. (Ocul Immunol Inflamm. 2015)
significant
reduction in
inflammation
recurrences 6
m before and 6
m after
surgery with
Ozurdex
Uveitis and Ozurdex
(Dexamethasone Intravitreal Implant)
IOP
remained
stable
Ozurdex safely and effectively controlled postoperative
inflammation in eyes with chronic recurrent uveitis during
anterior segment surgery .
Caution :Ozurdex use is now contraindicated in posterior
capsule rupture and ACIOLs. (J Ocul Pharmacol 2015)
Diabetic patients
The ratio of fibrinous uveitis, PS, and PCO
was found higher in the diabetic group
• Diabetic patients should be monitored
more carefully for fibrinous uveitis and PS
in the early postoperative period and for
PCO in late postoperative period
Anterior segment complications after
phacovitrectomy in diabetic and
nondiabetic
patients.
(Eur J Ophthalmol. 2013 )
Low grade chronic endophthalmitis caused by P.acnes
Ophthalmologe. 2015
-Chronic indolent inflammation, misdiagnosed as
noninfectious uveitis.
This form of endophthalmitis is often unsuccessfully treated
with corticosteroids.
-It caused by Propionibacterium acnes .
-It is difficulties in establishing diagnosis of this form of
endophthalmitis as well as the benefits of pars plana
vitrectomy, intravitreal antibiotics and posterior
capsulectomy for successful treatment in such cases.
Massilia timonae as cause of chronic endophthalmitis
following cataract surgery. J Cataract Refract Surg.2015
Uveitis-glaucoma-hyphema (UGH):
UGH:
1.ACIOL
2.Malpositioned PCIOL
3.In-the-bag placement of intraocular lens. BMJ Case Rep. 2016
-A 48-year-old man with blurred vision after an
uneventful cataract surgery treated for anterior uveitis.
-The AC inflammation persisted despite topical steroids
for 2 months, and IOP was high.
-PCIOL was in the bag and well covered by capsulorrhexis
margin.
-Dilated gonioscopy revealed superior haptic
displacement due to a tear in equatorial bag.
-This case highlights the importance of dilated gonioscopy
and a rare possibility of UGH in an eye with a well-placed
IOL.
THANKS FOR YOUR ATTENTION