Cataract Surgery in the Setting of Scleritis

Purpose: To report the clinical profile of cataract and its surgical management in a scleritis cohort from India.

Methods: We conducted a retrospective review of medical records of 39 eyes of 32 consecutive patients with scleritis who underwent cataract surgery in a tertiary eye care institute.

Results: The mean age at presentation was 50.9 ± 11.1 years and 65.6% of the patients were female. Five patients (15.6%) were ≤ 40 years of age. Necrotizing scleritis (56.4%) was the most common subtype of scleritis in this cohort followed by diffuse anterior scleritis (28.2%), nodular scleritis (12.8%). The preferred incision for phacoemulsification was clear corneal in 30 eyes (77%). In the immediate post-operative period, four eyes (10.2%) developed severe corneal edema, one eye had descemet membrane detachment. Anterior chamber reaction was observed in 18 eyes (46.1%). Fifteen eyes (38.4%) developed raised intraocular pressure and two required surgical intervention after 3 months of cataract surgery. Early posterior capsular opacification was observed in 5 eyes (12.8%) and cystoid macular edema in 2 eyes (5.1%).

Conclusion: In addition to providing a distinct pattern of cataract, index study showed that long-term control of scleral inflammation prior to the cataract surgery remains the primary requisite for the successful outcome.

Keywords: Scleritis; anterior nodular scleritis; methotrexate; necrotizing scleritis; phacoemulsification.