Infectious Uveitis and Cataract: Treatment Strategies and Current Approaches

Infectious uveitis is characterized by inflammation triggered by microorganisms in the uveal tissues of the eye and constitutes a significant risk factor for cataract formation, both due to the chronic course of the disease itself and the widespread use of corticosteroids in treatment. This review comprehensively evaluates current approaches and treatment strategies related to the planning, implementation, and follow-up processes of cataract surgery in uveitis caused by viral, bacterial, and parasitic infections. Uveitis-associated cataracts are frequently posterior subcapsular, and a minimum three-month inactive period and eradication of active infection before surgery are essential prerequisites. In the preoperative period, alongside microorganism-specific treatments, inflammation control should be ensured through perioperative steroid prophylaxis. For example, in uveitis caused by herpes viruses, antiviral prophylaxis is recommended to reduce surgery-induced recurrence risk; in bacterial etiologies such as tuberculosis or syphilis, microbial treatment and serological control before surgery are mandatory. In cataract surgery, phacoemulsification is preferred; management of pupillary synechiae and selection of intraocular lenses (especially hydrophobic acrylic monofocal IOLs) directly influence surgical success. In the postoperative period, continuation of agent-specific prophylactic treatment is critically important since surgical stress and immunosuppressive treatments may trigger reactivation of the infection. The most common postoperative complications include recurrence of uveitis, cystoid macular edema, posterior capsule opacification, and glaucoma. Literature reports indicate that with appropriate management, 70–90% of uveitis patients achieve visual acuity of 20/40 or better. However, if permanent anatomical impairments such as macular scarring or optic nerve damage exist, the visual benefit of surgery may be limited. Therefore, the surgical decision should be made through a multidisciplinary approach, patient education, and management of realistic expectations. In conclusion, cataract surgery in patients with infectious uveitis can be challenging but may serve as an effective component of visual rehabilitation with careful preoperative planning, appropriate intraoperative techniques, and rigorous postoperative monitoring.