Primary Intraocular Lens Implantation in Pediatric Uveitis

Abstract

To evaluate the visual outcome and postoperative complications of cataract surgery with posterior chamber intraocular lens implantation in children with uveitis. Design: A multicenter, retrospective, interventional case series. The setting included 3 medical centers in Israel. The interventions were cataract surgery and intraocular lens implantation. Aggressive preoperative and postoperative systemic and topical anti-inflammatory treatment was instituted. The main outcome measures included postoperative inflammation, complications, and visual outcome. Results: Children with juvenile rheumatoid arthritis (JRA)-associated uveitis were seen and underwent cataract surgery at an earlier age, and had a lower preoperative visual acuity and more severe uveitic complications when first seen, than those with non-JRA-associated uve-itis. Visual acuity improved by 2 or more lines in all patients, and in 13 eyes the final visual acuity was 20/40 or better. Postoperative complications included elevated intraocular pressure, posterior and anterior capsular opacities, and macular dysfunction. Conclusions: Compared with those with non-JRAassociated uveitis, children with JRA-associated uveitis tend to have more severe manifestations of disease when first seen and after surgery, but there is no significant difference in postoperative course or complications. Intraocular lens implantation, including small-incision, foldable, intraocular lenses, is well tolerated, when combined with aggressive medical treatment, for controlling inflammation. We believe that intraocular lens implantation is not contraindicated in those with pediatric uveitis, including uveitis associated with JRA.

Cataract Surgery with Primary Lens Implantation in Children with Chronic Uveitis

“…1 It occurs in 52% of children with uveitis 2 and is the most frequent cause of vision loss. 2 Furthermore, this reduction of visual acuity in children can have a major impact on behavioral development.…”

Surgical Management of Severe Complications Arising from Uveitis in Juvenile Idiopathic Arthritis

“…An example of such a measure is an anterior vitrectomy at the time of cataract surgery. Postoperative complications which have been observed in uveitis, sometimes after several months or years of quiescence, include the development of thick secondary retrolental membranes, hypotony, ERM and macular edema [12,13,14,15,16]. …”

“…In a time domain OCT study of children with JIA, 84% were found to have signs of maculopathy [7]. Following cataract surgery, in the absence of a vitrectomy, overt cystoid macular edema is observed in 10-40% of children [12,13,14]. Following a pars plana vitrectomy, there is resolution of preoperative macular edema in more than 50% of children indicating the value of this additional step [20,24,25].…”

“…Glaucoma is a known risk in JIA patients [12,14]. While secondary angle closure is seen in JIA-induced glaucoma with advanced anterior segment involvement, overall open angles are observed most frequently.…”

Kataraktchirurgie bei Uveitis im Kindesalter

“…Postoperativ neigen diese Augen, auch ohne IOL, zu zahlreichen Komplikationen mit foudroyanter Fibrinreaktion, posterioren Synechien, retrolentalen Membranen, zystoidem Makulaçdem, Hypotonie und Phthisis bulbi [6,23]. Mit dem konsequenten Einsatz moderner immunsuppressiver Strategien werden aber erstmals auch günstige Ergebnisse nach IOL-Implantation bei Kindern mit JIA-assoziierter Uveitis berichtet [15,21]. In einer großen retrospektiven Studie konnte gezeigt werden, dass unter strikter Kontrolle der Entzündungsaktivität mit Intraokularlinsen in vielen Fällen sehr gute Visusergebnisse erzielt werden, obwohl Komplikationen nicht vollständig vermieden werden [14].…”