Surgical management of cataract and posterior chamber intraocular lens implantation in Fuchs' heterochromic iridocyclitis

Background: To determine the inflammatory course and level of visual rehabilitation after cataract extraction and posterior chamber lens implantation in patients with Fuchs' heterochromic iridocyclitis complicated by cataract. Methods: In a clinical trial, 32 eyes (visual acuity of 20/160 or worse) of 30 patients underwent extracapsular cataract extraction (19 eyes) or lensectomy (13 eyes) accompanied by posterior chamber intraocular lens implantation. Indirect ophthalmoscopy was performed intraoperatively prior to intraocular lens implantation and the extent of vitreous haze was assessed. If vitreous haziness was 3+ or more, core vitrectomy (two eyes) or three-port pars plana deep vitrectomy (four eyes) was performed. Results: After an average follow up of 14.4 months (6 to 24 months), there was no statistically significant increase in cell and flare in the anterior chamber and vitreous or in keratic precipitates compared with the preoperative status of the eyes. However, 12% of the eyes developed synechiae (anterior and/or posterior) in comparison to preoperative condition (p < 0.05). Eighty-seven percent of the eyes gained visual acuity of 20/40 or better (P < 0.005). Using the logistic regression model, a higher level of preoperative inflammation was associated with reduced likelihood of gaining visual acuity of 20/25 or more (OR = 0.25, 95% CI 0.049, 1.255). The complications of surgery were synechiae, 12%; opaque posterior capsule, 12%; vitreous loss, 3%; chronic glaucoma, 3%; and retinal detachment, 3%. Conclusions: Implantation of a posterior chamber intraocular lens can be well tolerated in patients with Fuchs' heterochromic iridocyclitis. Vitrectomy, whenever indicated in addition to cataract extraction, improves visual rehabilitation.