Advances in the management of uveitic cataract: current strategies and emerging perspectives.

Abstract

Purpose: This review aims to summarize the current knowledge concerning the management of cataract in patients with uveitis.

Methods: A meticulous literature search was performed in the PubMed database. A supplementary search was made in Google Scholar to complete the collected items. Studies published up to the end of 2024 were included based on their relevance. To ensure a comprehensive review process, we carried out a critical appraisal evaluating study design, methodology, sample size, and potential bias. Studies that did not provide apposite information or lacked methodological rigor were excluded.

Results: Cataract is one of the most frequent complications in patients with uveitis and requires a detailed management to achieve good anatomical and functional outcomes. Comprehensive assessment, patient selection, and preoperative counselling are mandatory, while inflammation must be in remission for at least 3 months before surgery. Since even mild chronic inflammatory activity can contribute to the cumulative damage associated with uveitis, perioperative anti-inflammatory treatment is crucial. Surgery for uveitic patients is made more difficult by a number of factors (such as poorly dilating pupils), but better results can be achieved with advanced surgical methods, careful postoperative monitoring, and timely management of complications. Moreover, the implication of steroid-sparing agents is also very useful in the optimal long-term control of the inflammation.

Conclusions: Cataract surgery in patients with uveitis can be highly challenging. The ophthalmic surgeon must conduct a thorough preoperative assessment, develop a strategic plan for potential intraoperative challenges, and be prepared to manage possible postoperative complications. Recent advances including artificial intelligence, robotic surgery, next-generation intraocular lenses and novel drugs are expected to enhance the management of cataract in uveitic eyes.