Combined phacovitrectomy with preoperative cyclosporin A in management of resistant panuveitis

PURPOSE: This paper evaluates the visual outcome and report complications and uveitis control of one-stage combined pars plana vitrectomy, phacoemulsification, and intraocular lens (IOL) implantation in eyes with resistant noninfective uveitis after preoperative control by oral cyclosporin A (CSA). METHODS: This paper uses an interventional case-series study of ten eyes in nine patients with panuveitis, controlled by oral CSA with the least dose of topical and systemic steroids. All eyes underwent standard pars plana vitrectomy, microcoaxial phacoemulsification, and IOL implantation. The data recorded were visual acuity (VA), intraoperative and postoperative complications, and recurrences of activity through a minimum follow-up of 6 months. RESULTS: The mean logarithm of the minimum angle of resolution (logMAR) significantly improved from 1.597 at baseline (3/60 Snellen’s equivalent), to 0.819 at the 3-month follow-up meeting (6/45 Snellen’s equivalent), to 0.663 at the 6-month postoperative visit). VA improved in 70% of eyes, worsened in 20%, and stabilized in 10%. There was improvement (>6 lines) in 30% of eyes. The rate of posterior synechia formation and uncontrollable glaucoma decreased from 60% preoperative to 10% postoperative (P = 0.01). There was significant decline in the number of eyes requiring topical steroids from 100% preoperative to 50% postoperative (P = 0.01). The same is true for oral CSA, which decreased from 100% preoperatively to 10% postoperatively. CONCLUSION: A single-stage combination of phacovitrectomy and IOL implantation is able to control noninfective panuveitis with less need for systemic treatment and topical steroids, and results in fewer incidence of glaucoma and posterior synechia. Furthermore, it restores useful postoperative vision.