What options would you consider for removing dense fibrin deposits from an IOL in a patient with chronic uveitis?

Pre-treat with a steroid and nonsteroid drop, use a low-power YAG laser anterior offset to remove, and post op continue with pre op regimen for as long as recurrence is necessary, then slowly taper off.

First, to ensure uveitis is adequately controlled before intervention, ongoing or recurrent intraocular inflammation increases postoperative inflammatory risk.

If I am to do a YAG, I would want the patient to have no inflammation for 1-2 months. If I am to do a surgery, you would need to wait longer, 3-6 months off inflammation, while the patient is on zero or minimal medications. Published studies and reviews for uveitic cataract surgery generally describe at least 3 months of quiescence before surgery. One 2023 cohort required disease inactivity for at least three months.

Treatment options:

• Nd: YAG disruption/removal - for anterior membranes, I would use these settings: 100 microns anterior defocus, power can go up to 9, depending on the...

When they are quiet, a YAG works fine.

But caution them, it often comes back with the next round or 2 of inflammation.