Purpose: The authors analyzed the incidence of cataract development and the visual outcome of cataract surgery performed on patients with sarcoidosis-associated uveitis who were treated at the Immunology Service at the Massachusetts Eye and Ear Infirmary during a 17-year period.
Methods: The records of 102 patients with sarcoidosis-associated uveitis who were treated with topical and regional corticosteroids, systemic nonsteroidal anti-inflammatory drugs, systemic steroids, or with systemic immunosuppressive chemotherapy were reviewed. Cataract surgery was performed on those eyes in which cataract developed, resulting in decreased visual acuity of 20/100 or less. The incidence of cataract development and visual results of cataract extraction and intraocular lens implantation were analyzed.
Results: In this cohort of 102 patients, visually significant cataracts that warranted surgery developed in 10 (16 eyes). In addition, four patients (5 eyes) had a visually significant cataract at the time of first evaluation. A total of 14 patients (21 eyes) underwent cataract surgery. Posterior chamber lens implantation accompanied cataract surgery in 19 (90.5%) of 21 eyes. The average final visual acuity of the 21 eyes after cataract surgery was 20/51, and 61% of the eyes achieved a stable visual acuity of 20/40 or better. The major causes of the decreased visual acuity in patients who had less than 20/40 visual acuity were sequelae of chronic posterior uveitis, cystoid macular edema, epiretinal membrane, and glaucomatous optic nerve damage.
Conclusion: Posterior chamber lens implantation and cataract surgery in patients with sarcoidosis-associated uveitis can be well tolerated when absolute control of the inflammation is achieved. Pre-existing retinal pathology and glaucoma as a result of uncontrolled inflammation resulting in permanent ocular structural damage were found to be the most important factors for determining the postoperative final visual acuity.