Cataract Surgery in Uveitis and Diabetes: Planning and Aftercare
Last updated: November 2026
Uveitis and diabetes are the two commonest reasons a routine cataract operation becomes a high-risk one. The surgery is similar; the planning and aftercare are what protect the macula.
Uveitic cataract: before surgery
- The eye should be quiet for at least 3 months (no AC cells) before elective surgery.
- Peri-operative steroid cover: topical steroid increased 1–2 weeks before; oral prednisolone (about 0.5–1 mg/kg/day for 1–2 weeks before), or intravenous methylprednisolone at surgery, or intravitreal/intracameral dexamethasone or triamcinolone, according to the uveitis type.
- Prophylactic oral aciclovir or valaciclovir in herpetic uveitis.
- Continue systemic immunosuppression; plan with the uveitis specialist.
Uveitic cataract: surgery
- Posterior synechiae and small pupils: synechiolysis, iris hooks or a ring; avoid excessive iris handling.
- A hydrophobic acrylic IOL in the bag is preferred; avoid sulcus and anterior chamber IOLs, and silicone IOLs if vitrectomy with silicone oil may be needed.
- In JIA-associated uveitis, IOLs are now implanted in selected well-controlled children; aphakia may still be safer in poorly controlled disease.
- Fuchs heterochromic iridocyclitis usually does well with routine steroid cover.
Diabetic cataract
| Problem | Plan |
|---|---|
| Centre-involving DME | Treat before surgery where possible (anti-VEGF); consider anti-VEGF or a steroid implant at the time of surgery in eyes with recent DME |
| Proliferative retinopathy | Complete PRP (or anti-VEGF) before surgery if the view allows; if not, early PRP after surgery |
| Post-operative macular oedema | Topical NSAID plus steroid for 4–6 weeks; OCT at follow-up |
| Retinopathy progression | Retinopathy can worsen after surgery: dilated review at 1 and 3 months |
| Other | More PCO, poorer pupil dilation, slower epithelial healing; control blood sugar on the day |
After surgery in both
- Taper steroids slowly; watch for rebound inflammation and steroid-induced IOP rise.
- OCT if vision is not as expected: cystoid macular oedema is the main cause of poor outcome.
Where residents slip
- Operating on an inflamed uveitic eye.
- Placing a sulcus or anterior chamber IOL in uveitis.
- Leaving untreated PDR or DME before cataract surgery.
- Stopping post-operative drops too early in a diabetic eye.
Test yourself: flip cards
Related: JIA-Associated Uveitis: Screening Schedule and Treatment, Diabetic Retinopathy: Classification and Management for Residents, Medical Fitness Before Eye Surgery: BP, Sugar, Tamsulosin, GLP-1 and SGLT2.
Key sources
- Mehta S, et al. Perioperative care of patients with uveitis undergoing cataract surgery. Surv Ophthalmol (review)
- Baker CW, et al. Macular edema after cataract surgery in eyes without preoperative central-involved DME (DRCR Retina Network). JAMA Ophthalmol. 2013;131:870-879
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