Significant Vision Improvement Occurs in Scleritis Patients Following Cataract Surgery

Rates of retinal detachment and development of cornea edema/bullous keratopathy in scleritis patients were similar in this cohort as with those patients in the IRIS Registry developing postoperative CME, but were higher than those without this complication. Photo: Nimesh Patel, MD/Bascom Palmer. Click image to enlarge. The Intelligent Research in Sight (IRIS) Registry offers a wealth of information for researchers looking at certain topics. Scleritis has a low incidence, making it a condition which is typically only discussed in small case series in the literature. A newly published study in Cornea, however, had researchers use the IRIS Registry to retrospectively investigate demographic and ocular features of scleritis patients undergoing cataract surgery, since the condition and treatment for it can cause cataract development and progression.Patients with a preexisting scleritis diagnosis who underwent cataract surgery were included, totaling 6,716 eyes of 5,618 patients. It was found that, after surgery, average best visual acuity (BVA) improved by about three Snellen lines. Postoperative complication rates were low, with cystoid macular edema (CME) occurring in 5%, retinal detachment in 2% and corneal edema also in 2%. Pre-op CME (adjusted odds ratio [aOR]: 2.78) and poorer pre-op BVA (aOR: 9.10) were associated with post-op BVA worse than 20/40. After adjusting for factors of age and bilaterality, female sex (aOR: 1.15) and smoking (aOR: 1.63) were found to be risk factors for cataract surgery.Upon a more detailed discussion, the authors of the study relay that the visual improvement seen in these patients after the procedure was maintained through the first year, with 86% of patients by six months post-op achieving a visual acuity of 20/40 or better. This somewhat reflects a previous investigation, which found that scleritis, in opposition with other types of ocular inflammation, was identified as a prognostic factor for increased odds of achieving 20/40 or better vision one year following cataract surgery. For those who do present with worse VA, “cautious counseling of patients presenting with poorer preoperative acuity about expected postoperative improvement in vision is recommended,” the investigators elucidate.Factors of older age, female sex and current or former smoking status were all found as risks for requiring cataract surgery; greater odds existed for current than former smokers. Related to this, the authors recommend “smoking cessation counseling should be provided to patients presenting with scleritis to reduce the risk of cataract requiring surgery as a complication of the disease course.”With observed complications, close monitoring should continue for CME detection in scleritis patients in the postoperative period—especially in those with a history of CME. The researchers also add that “patients with scleritis considering cataract surgery should receive preoperative counseling about their increased risk for damage to ocular structures beyond the sclera,” which may include CME, retinal detachment and corneal decompensation. Click here for the journal source. Armbrust KR, Kopplin LJ. Cataract surgery in patients with scleritis in the United States: an IRIS Registry (Intelligent Research in Sight) analysis. August 13, 2025. [Epub ahead of print].This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.