Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis

Abstract

ABSTRACT.Purpose: Management of uveitic cataract in patients with juvenile idiopathic arthritis (JIA) is challenging, and intraocular lens (IOL) implantation is controversial. This study investigated the outcome after minimally invasive surgery with IOL implantation. Methods: Retrospective analysis after phacoemulsification with in-the-bag IOL implantation was performed in 16 patients (17 operations) with ANA-positive JIAassociated chronic uveitis. In these patients, 25 G capsulectomy and anterior vitrectomy was performed and they received an intravitreal triamcinolone (TA) injection. Results: Mean age at uveitis onset was 5 ± 2 years, and surgery was performed at a mean age of 11 ± 2.2 years. Preoperatively, uveitis was inactive in all patients, and visual acuity was logMAR 0.8 ± 0.44; additional uveitis complications were present in all patients, and 15 patients were receiving systemic immunosuppression ⁄ biologicals. After surgery (mean follow-up 26.5 ± 11.7 months), presence of cystoid macular oedema, papilloedema, ocular hypertension ⁄ glaucoma and hypotony did not increase compared with baseline. There was no significant worsening of AC inflammation (by cell numbers and laser flare values). IOL deposits persisted in four patients, and synechiae developed in eight. The visual acuity was improved ( ‡2 lines) in all patients (mean logMAR 0.3 ± 0.24). Retrolental membrane formation was not noted. Secondary capsular opacification was observed in seven patients, requiring Nd:YAG capsulotomy in five of them. Conclusions: Phacoemulsification and in-the-bag IOL implantation may improve visual outcome in JIA-associated uveitis with minimally invasive surgical technique and intravitreal TA injection. Well-controlled uveitis with appropriate use of topical steroids and systemic immunosuppression or biologicals appears as a perioperative requirement.

Juvenile idiopathic arthritis-associated uveitis

“…Removal of the lens by phacoemulsification is the usual surgical treatment for a cataract that is impacting significantly on visual acuity [72]. Complete control of intraocular inflammation for at least 3 months prior to surgery is associated with improved outcomes [73,74]. Aggressive Case series (n = 3) and case report showing efficacy.…”

Managing juvenile idiopathic arthritis–associated uveitis

“…Although the IOL implantation has been controversial, there is increasing evidence that this is a safe procedure with current surgical techniques. 112 However…”

Cataract surgery with primary intraocular lens implantation in children with uveitis: Long-term outcomes

“…The two most recent studies of JIA-associated uveitis 19,20 confirmed the requirement of maximum perioperative control of inflammation without an increased risk for ocular complications.…”