Survey of expert practice and perceptions of the supporting clinical evidence for the management of uveitis-related cataract and cystoid macular oedema

Ocul Immunol Inflamm. 2011 Oct;19(5):353-7. doi: 10.3109/09273948.2011.592260. Epub 2011 Aug 8.

Abstract

Purpose: To survey the practice of uveitis experts in the management of uveitic cataract and cystoid macular oedema (CMO).

Methods: A structured questionnaire containing two clinical scenarios was sent to members of the International Uveitis Study Group (IUSG). The questionnaire surveyed both respondents' current practice and their perception of the supporting clinical evidence.

Results: For uveitic cataract, 70% required a 3-month inflammation-free period before surgery, and 76% gave a prophylactic preoperative systemic corticosteroid. For uveitic CMO, 87% gave corticosteroids, usually orally. Preferred second-line agents were methotrexate (39%), cyclosporin (24%), azathioprine (17%), and mycophenolate (7%). Respondents suggested the evidence underlying their decisions was either absent or relatively weak (levels III or IV), and in most cases personal experience was a factor.

Conclusions: This survey highlights areas of consensus and variation among uveitis experts in managing uveitic cataract and CMO, and emphasizes the need for further clinical trials to establish the best practice.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Azathioprine / therapeutic use
  • Cataract / drug therapy
  • Cataract / etiology
  • Cataract / therapy*
  • Cataract Extraction
  • Cyclosporine / therapeutic use
  • Expert Testimony*
  • Female
  • Health Care Surveys*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Macular Edema / drug therapy
  • Macular Edema / etiology
  • Macular Edema / surgery
  • Macular Edema / therapy*
  • Male
  • Methotrexate / therapeutic use
  • Middle Aged
  • Mycophenolic Acid / therapeutic use
  • Ophthalmologic Surgical Procedures
  • Surveys and Questionnaires
  • Uveitis / complications*
  • Young Adult

Substances

  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Cyclosporine
  • Mycophenolic Acid
  • Azathioprine
  • Methotrexate