Autoimmune Diseases of the Retina and Cataract: Treatment Strategies and Current Approaches

This review provides a comprehensive overview of the surgical management of cataract in patients with uveitis associated with retinal autoimmune diseases. Cataract in uveitic eyes develop as a result of chronic intraocular inflammation and long-term steroid therapy and are one of the most common causes of vision loss. Cataract surgery in this patient group involves varying difficulties depending on systemic and ocular disease activity and accompanying ocular comorbidities. A detailed ophthalmologic and systemic evaluation should be performed before surgery, especially considering the status of the retina and optic nerve structures. Preoperative control of inflammation for at least three months is recognized as an important prognostic factor for reducing postoperative complications and enhancing surgical outcomes. Appropriate immunosuppressive therapy with local and systemic corticosteroids before, during, and after surgery plays a critical role in reducing postoperative inflammation and the risk of developing cystoid macular edema (CME). Phacoemulsification with intraocular lens implantation is the preferred surgical technique for most patients with uveitic cataract. Surgery in these cases is often challenging because of miotic pupil, posterior synechiae, iris atrophy, zonular weakness, and pupillary membranes. Therefore, the use of pupil dilators, iris manipulations, and additional procedures may be required. Patients should be closely monitored postoperatively for excessive inflammation, CME, increased intraocular pressure, hypotony, and other potential complications. Recent advances in surgical techniques, immunomodulatory therapies, and intraocular lens technologies have significantly improved the safety and visual outcomes of cataract surgery in patients with uveitis. However, an individualized approach should be adopted for each patient and it should be kept in mind that the risks of unforeseen complications are higher than those of traditional cataract surgery, and careful follow-up should be maintained after surgery.