The uveal tract is the main source of blood supply to the eyeball. Causes of uveitis include: infection, tumor, trauma, and autoimmune. Chemical mediators of acute inflammation include serotonin, complement, and plasmin. Leukotrienes, kinins, and prostaglandins modify phase 2 of the acute inflammatory response through antagonism of vasoconstrictor factors. The complex of immunity response is a leukocyte attractant. Polymorphonuclear leukocytes, basophils, and mast cells all contribute to inflammation but lymphocytes predominate in uveitis and endophthalmitis. The International Uveitis Study Group (IUSG) classified uveitis as follows: Anterior uveitis; Intermediate uveitis; Posterior uveitis and Pan uveitis. In this article, uveitis caused by crystalline lens and intraocular lens with or without dislocation is presented including early diagnosis/ treatment for vision maintenance as well as for better quality of life.

The uveal tract is the major source of blood supply to the eyeball. Causes of uveitis include: bacterial infections, viruses such as zona, herpes [1,2,3,4], trauma, tumors (retinoblastoma, lymphoma) [5] and autoimmune (sympathetic ophthalmitis, HLB-A5, HBL-A27) [6] or a combination of these. Chemical mediators of acute inflammation include serotonin, complement, and plasmin. Leukotenes, kinins, and prostaglandins modify phase 2 of the acute inflammatory response through antagonism of vasoconstrictor factors. The complex of immunity response is attracted leukocytes. Polymorphonuclear leukocytes, basophils, and mast cells all contribute to inflammation but lymphocytes predominate in uveitis, and endophthalmitis [7,8,9,10]. In 1987, the International Uveitis Study Group (IUSG) classified uveitis as follows: anterior uveitis (46%), mediate uveitis (8%), and posterior uveitis (34%) and pan uveitis (12%) [6]. In this article uveitis caused by crystalline lens and intraocular with or without dislocation is presented included early diagnosis/ treatment for vision maintenance as well as for better quality of life.

The first is uveitis caused by the crystalline lens of the eye. 

1. Uveitis caused by crystalline lens: Classification of uveitis caused by crystalline lens has 3 types: [8]. The 3 morphologies phaco anaphylactic endophthalmitis, phytotoxic uveitis, and phagocytic glaucoma may be independent or combined in the course of the patient's course.

1.1 Phacotoxic uveitis: caused by protein lens after extracapsular surgery is granulomatous uveitis which is a mild uveitis without an epithelial cell response tissue as in phaco anaphylactic endophthalmitis. Medical treatment will have the expected results. However, if medical therapy does not improve, consider chronic intraocular lymphoma resembling posterior uveitis requiring vitreous biopsy for diagnosis. Treatment needs to be combined with immunosuppressants to be effective in vision as well as prolong life for patients [9,10].

1.2 Phacoanaphypactic endophthalmitis is a type 3 hypersensitivity reaction [10]. Phacoanaphypactic endophthalmitis is an immune response to vitreous proteins released after actual trauma or surgery. The normal protein lens isolates itself from the immune system. It is possible that the protein lens is antigenic to aqueous exposure or may modify tolerance leading to acute or chronic inflammation. The cornea may precipitate. The iris is congested and sticky. The aqueous humor is not clear, the Tyndall's sign is positive (+). No damage to the retina was seen. Neutrophils with epithelial cells, macrophages, lymphocytes, and mast cells have surrounded the lesion. These may lead to sympathetic ophthalmitis [9,10]. It is necessary to diagnose early and differentiate it from other endophthalmitis such as bacterial infections such as staphylococci, streptococci, bacilli…, and Candida fungi… to treat the root cause [2,3].

1.3 Phacolytic glaucoma is raised intraocular pressure caused by occlusion of the trabecular meshwork by hypermature lens and macrophages, without iris adhesions. The enlarged macrophages have been seen in aqueous humor in the anterior chamber after aspiration. Phacolytic glaucoma usually occurs on hypermature lenses, but now it is rare. Early detection is necessary for combined medical and surgical treatment to maintain better vision [2].

2.1 Uveitis with or without IOL implant:

In case of an IOL implant, phaco anaphylactic endophthalmitis can occur, and removing the IOL still has no effect. Differential diagnosis with other endophthalmitis caused by Propionibacterium acnes usually develops later after IOL implant. The mechanical rubbing of the skin, the IOL loop created on the iris leads to inflammation. Rate is 1% [9]. IOL mobility, or fixation to the iris, can damage the corneal endothelium, iritis, and cystoid macular edema. Anterior uveitis hemorrhagic glaucoma syndrome is less and becomes lesser. Polymer, silicone used to produce IOL has the ability to activate complement and chemotaxis of polymorphonuclear leukocytes leading to inflammation. Cases of IOL-induced uveitis that can lead to chronic inflammation, glaucoma, cystoid macular edema, and endothelial decompensation require removal of the IOL and percutaneous corneal transplantation. Consideration should be given to placing an IOL over an eye with pre-existing uveitis [9,10]. In case of without IOL intraoperative cataract removal, uveitis may occur in the early postoperative period. All lens matter should be removed. Phacoanaphypactic endophthalmitis can occur in the other eye when one eye has previously been removed crystalline lens. During extracapsular surgery, the residual lens material is potentially inflammatory but transient [9].

2.2 Uveitis due to IOL dislocation after surgery period [11]:

Over the past decade, the risk of serious complications has decreased thanks to advances in surgical tools and techniques. Rare complications include deviation of the IOL from position. IOL dislocation is a rare but serious complication with an incidence of 0.2% to 3%. [11]. The most common symptom of IOL dislocation is vision changes depending on the severity of the IOL deviation. Symptoms may appear as Blurring; Double look; See the edge of the IOL. Complications of IOL dislocation in addition to uveitis can include bleeding, corneal edema, glaucoma, endophthalmitis, macular edema, and retinal detachment. In most cataract surgery, the IOL is placed laterally. in bag. In some situations, this extremely thin capsule ruptures and leads to a compromised IOL. IOL dislocation can occur days to years after surgery. It may be the result of factors during use as well as the initial surgery, trauma to the eye, or diseases that affect the stability of the capsule. Risks in addition to Uveitis include: Trauma; Anterior vitrectomy; Pseudo exfoliation syndrome (a condition that causes instability of the IOL capsule; connective tissue disorder Diagnosed by a detailed eye exam, careful examination of the peripheral retina. The deviation should be photographed to document the extent. When the retina cannot be seen directly, an ophthalmic ultrasound may be helpful. Treatment and prognosis are based on the characteristics of the IOL dislocation. Several different approaches are as follows: When vision is affected and the patient is having symptoms, surgery becomes necessary In this surgical procedure the vitreous is removed to prevent the retina from pulling. IOL deviation techniques are divided into 2 categories: 1. Repositioning the IOL dislocation to a more stable position. Many factors including the style and condition of the IOL are the availability of the existing IOL. 2. Other IOL changes: The IOL dislocation is removed and a new IOL is inserted Potential complications of surgery include uveitis, infection, glaucoma, retinal detachment, bleeding, and re-dislocation of IOL Close monitoring and management of the IOL may allow complications to be avoided. In the case of IOL dislocation with uveitis, it is important to distinguish uveitis from anaphylaxis in order to predict the patient's prognosis. Careful assessment before, during, and after surgery is imperative to achieve a good outcome. With timely and careful management, patients with IOL dislocation uveitis have good visual acuity after a surgical correction combined with medical therapy with anti-inflammatory drugs.  [9,10].

Uveitis caused by the crystalline lens and intraocular lens is a hypersensitivity reaction. Early diagnosis for early treatment of the cause is first. A combination of medical and surgical treatment is needed. In the case of IOL dislocation with uveitis, it is necessary to distinguish uveitis due to anaphylaxis to predict the patient's prognosis. Surgery and anti-inflammatory drugs are effective in most patients to maintain vision and quality of life. Chronic intraocular lymphoma resembling posterior uveitis requires vitreous biopsy for diagnosis after treatment with anti-inflammatory is not effective and must be combined with immunosuppressant drugs to be as effective as maintaining vision and prolonging the patient's life.

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