How do you approach perioperative steroids for a quiescent uveitis patient undergoing cataract surgery?

Preop:

If the patient is using topical steroids chronically, I increased the dose of the drops to four times a day the week prior to surgery.

If the patient is using chronic oral prednisone, I will increase the prednisone to 0.5 mg/kg, 3 days prior to surgery, followed by a quick taper every 3 days back down to the dose they were taking prior to surgery.

Day of surgery:

If the patient is not a steroid responder, I would do a subtenon's triamcinolone injection (STK) at the end of the case. If they are steroid responders and STK is contraindicated, I do IV methylprednisolone at the time of surgery (500 mg- 1,000 mg). Some people inject a dexamethasone implant.

Post op:

After the surgery, I tend to be more aggressive with the steroids manage...

I do subconjunctival Kenalog after routine cataract surgery, and unless the patient has had multiple bouts of difficult uveitis, I do not do any pre-operative steroid and will just see how they react post-operatively.

Most do very well with just the subconjunctival Kenalog and do not need any further drop therapy.

I agree with Dr. @Dr. First Last I think every patient who has had uveitis before requires more steroids perioperatively. For everybody, I do more frequent prednisolone, generally every two hours while awake after surgery.

For those with posterior/pan/intermediate uveitis, especially when it was tougher to treat or with CME, I like dexamethasone implant 1-2 weeks prior to surgery. Subtenon Kenalog is another option in less severe cases.

Anterior uveitis can do increased topical a few days prior to continuing into postop. Consider difluprednate, especially when IOP response isn’t a concern.

For those we can’t do injections (significant steroid response or otherwise), oral prednisone 1 mg/kg up to 60 mg starting 3-4 days prior and tapering re...