Investigating Non-Ocular Factors Affecting Postoperative Recovery Following Uveitic Cataract Surgery

Ata Baytaroğlu,1 Şerife Nur Çiftci,2 Iffet Merve Uçar Baytaroğlu,3 Suzan Doğruya,2 Hatice Daldal2 1Department of Ophthalmology, Uşak Training and Research Hospital, Uşak, Türkiye; 2Department of Ophthalmology, Uşak University, Uşak, Türkiye; 3Department of Rheumatology, Uşak Training and Research Hospital, Uşak, TürkiyeCorrespondence: Ata Baytaroğlu, Department of Ophthalmology, Uşak Training and Research Hospital, Uşak, Türkiye, Email [email protected]: Cataract surgery in eyes affected by uveitis presents unique challenges, but the non-ocular factors influencing postoperative recovery are not fully understood. While earlier studies have mainly focused on ocular prognostic factors, variables such as cumulative inflammatory burden, phacoemulsification energy, and systemic immunomodulation have not been thoroughly evaluated. This study aims to identify independent predictors of visual outcomes and steroid-free recovery time after cataract surgery for uveitic cataracts.Methods: This retrospective study included 54 eyes of adults with uveitis-associated cataracts who underwent phacoemulsification with intraocular lens (IOL) implantation at a single center. The primary outcomes were postoperative month-1 best-corrected visual acuity (BCVA) and steroid-free recovery time. Multivariable regression analysis identified independent predictors among preoperative BCVA, uveitis attack count, cumulative dissipated energy (CDE), and immunomodulatory therapy type. All patients on bDMARDs had been receiving therapy for at least 3 months prior to surgery and continued their regimen perioperatively.Results: The mean age of the patients was 38.6 ± 7.9 years. The diagnoses included axial spondyloarthritis (40.7%), Behçet’s disease (33.3%), juvenile idiopathic arthritis (11.1%), idiopathic uveitis (11.1%), and sarcoidosis (3.7%). Visual acuity improved from 0.23 ± 0.12 to 0.86 ± 0.12 (p< 0.001). The median steroid-free recovery period was 13 days. Independent predictors of postoperative BCVA (R2=0.63) included preoperative BCVA (β = +0.254, p = 0.016), uveitis attack count (β = − 0.014, p = 0.015), and CDE (β=− 0.009, p< 0.001). Steroid-free recovery (R2=0.70) was predicted by attack count (β=+1.29 days/attack, p=0.002), CDE (β = +0.95 days/unit, p< 0.001), and biologic DMARD therapy (β=− 5.09 days, p=0.006).Conclusion: Cumulative inflammatory burden and surgical complexity independently predict postoperative recovery in uveitic cataract surgery. Biologic DMARD therapy was linked to faster steroid-free recovery in this observational cohort, supporting further research into optimizing systemic immunomodulation before surgery. Prospective studies with larger sample sizes are needed to confirm these results.Keywords: uveitis, cataract, phacoemulsification, cumulative dissipated energy, biologic DMARD