Month: December 2017

What is Uveitis
Uveitis is the inflammation of the uvea, the pigmented layer that lies between the inner retina and the outer fibrous layer composed of the sclera and cornea.
Uvea has 3 main parts:
The iris is the coloured part of the front of the eye, and its central aperture is called the pupil. Inflammation of the iris is called iritis.
The ciliary body is a ring of muscle, which lies behind the iris. Inflammation of the ciliary body is called cyclitis. The iris and ciliary body are often inflamed together (iridocyclitis).
The choroid lines the inside of the back of the eye, and supplies blood for the retina, the light-sensitive film of the eye, which form images. The retina is often involved in inflammations of the choroid. These inflammations are called choroiditis and retinitis.
Uveitis is classified anatomically into anterior, intermediate, posterior, and panuveitis based on the part of the eye primarily affected.
Uveitis can be acute (starting suddenly and going away within weeks) or chronic (coming on gradually and lasting for months or more). Acute uveitis is sometimes recurrent.
Uveitis can lead to secondary problems in the eye such as the lens of the eye becoming opaque called cataract, and the pressure of the eye going up called glaucoma.

Causes of Uveitis
Uveitis has many possible causes and may be linked to inflammations elsewhere in the body, but in many people, the cause is not found. Some of the common causes of uveitis are as follows:
Autoimmune
The immune system in our body protects us against foreign bodies like bacteria or viruses. In autoimmune disease a part of our body (self) is mistaken as foreign and attacked by its own immune system. The result is inflammation, which can involve the eye and cause uveitis.
Infection
Uncommonly infections may cause uveitis.
Trauma
This includes some form of eye injury and / or eye surgery.
Malignancy
Rarely malignancies either affecting the eye primarily or secondarily from other parts of the body can cause ocular inflammation.
Associated medical condition
Some patients will have a medical condition, associated with uveitis. eg: sarcoidosis, Behcet’s disease and ankylosing spondylitis.
Idiopathic
This means no specific cause or association with other medical conditions can be found.

Symptoms of Uveitis
Anterior uveitis causes a painful red eye, made worse by bright light, whereas posterior uveitis is painless and causes visual blurring and floaters. If not treated optimally uveitis may cause permanent damage to vision.

Treatment of Uveitis
The treatment of uveitis depends on the type and severity of the disease. Uveitis is mostly treated with steroids, drugs that reduce inflammation. A few specific types of uveitis caused by infections are treated with specific antibiotics.
Steroids can be administered either as drops, injections around or into the eye or in the form of oral therapy in severe cases.
If the steroids alone cannot control the uveitis or if a high dose of steroid is needed to control the inflammation then a ‘second line’ immunosuppressant drug may be introduced. These medications require close monitoring, by a uveitis expert.
Uncommonly a surgery called vitrectomy may be needed to diagnose and sometimes treat severe forms of uveitis.

What is a Cataract?
The crystalline lens is a transparent structure in the eye, situated behind the iris, and its main function is to focus the light on the retina. A cataract is a naturally occurring aging change of the crystalline lens. The lens becomes cloudy and loses its transparency. This process is usually very gradual and results in slow decrease of vision, colours appearing less vivid and some patients might be also aware of glare.

Who is affected by this condition?
As cataract is a normal aging change, most people above the age of 60 will have some degree of cataract. However, cataracts might be encountered at a younger age if there is previous history of ocular surgery, trauma, diabetes or inflammation. Rarely, cataracts may be hereditary or congenital (when one is born with a cataracts).

What is the treatment of cataracts?
In the early stages, the vision can be corrected by changing of the spectacles. However, the definitive treatment is surgical. With the advancement of technology, cataract surgery has become a much safer procedure. It is usually done under local anaesthetic as a day case.

What does the surgery entail?
The surgery is called phacoemulsification and intraocular lens implantation. During the operation a very small self sealing incision is made into the cornea. The lens is removed by using ultrasound (phacoemulsification). The ultrasound helps to break down the cataract into small pieces so that they can be cleared away through a small incision. Once the cataract is removed, a new foldable lens is inserted into the eye that will help focus the light into the retina.

When is the right time for the cataract operation?
Cataract surgery is an elective procedure and the decision when to operate is strictly individual. Once cataracts start interfering with one’s quality of life then it would be appropriate to consider the cataract surgery. It is no longer required to wait until the cataracts are “ready” or “ripe” to undertake the surgery. However, if the cataracts are not causing any symptoms and the patient can do all his/her daily activities the surgery can be deferred till later date.

Are there any risks/complications with cataract surgery?
Nowadays, cataract surgery is considered to be one of the safest operations however there are still small risks. The most serious risk is of an infection or a severe bleed that can lead to loss of sight. Fortunately this is extremely rare. It occurs in less that 1 in 1000 patients. Other more frequent, however, not as serious risks include inflammation, disturbance of the capsule, where the new intraocular lens should be implanted, or some lens fragments dropping to the back of the eye. All these can be successfully managed either conservatively or with further surgical procedures. Vitreoretinal surgeons are well trained in managing the surgical complications of cataract surgery.