Cataract surgery in patients with Vogt-Koyanagi-Harada syndrome

Purpose. To evaluate the outcomes of cataract surgery in patients with Vogt-Koyanagi-Harada's (VKH) syndrome. Setting: Medical Research Foundation, Sankara Nethralaya, Chennai, India. Methods: Fifty-nine eyes of 39 patients with VKH syndrome who had cataract surgery between May 1985 and June 2001 were retrospectively analyzed. Results: Extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation was performed in 15 eyes and without IOL implantation in 31 eyes. Phacoemulsification with IOL implantation was performed in 13 eyes. Twenty-three eyes (38.9%) had mixed cataract (posterior subcapsular and posterior polar). Small pupils were managed by synechiolysis with an iris spatula (43 eyes) or iris hooks (8 eyes). Nine eyes were lost to follow-up and not included in the postoperative analysis. The mean postoperative follow-up was 39.4 months (range 9 to 120 months). Visual acuity improved by 1 or more lines in 40 eyes (80.0%). Subretinal gliosis and optic atrophy, sequelae of the syndrome, restricted improvement in vision in the remaining eyes. Posterior capsule opacification developed in 38 eyes (76.0%), of which 21 (42.0%) required a neodymium:YAG laser posterior capsulotomy. There were no significant differences in postoperative inflammation or syndrome reactivation between the types of surgery. Conclusions: The results show that cataract extraction in patients with VKH syndrome can be safely and successfully performed if there are good preoperative and postoperative control of inflammation, careful surgical planning, and meticulous surgical technique. The final visual outcome depends on the posterior segment complications of the syndrome.