Lam- Surgical management of cataracts in children with JRA uveitis
10
use. They reported good results, with a best-corrected visual acuity of 20/40 or better in 7 of 10
eyes, with a median follow-up of 28 months. The remaining three eyes in that study had a final
visual acuity of 20/50, 20/80, and hand motions vision. Complications leading to poorer visual
outcomes in these three eyes included glaucoma (1), macular edema (1), and recurrent secondary
membranes (1). Since Lundvall and Zetterstrom
10
did not report individual immunosuppressive
regimens, it is difficult to assess whether their regimen to control inflammation was comparable
to that used in this study.
BenEzra
and
Cohen
11
examined the outcomes after cataract surgery with PC IOL in 5 eyes of
5 children (aged 4 to 8 years) who had JRA-associated uveitis. Three eyes had postoperative
visual acuity of 6/240 or less. Factors that limited postoperative visual acuity included posterior
synechiae, macular edema, persistent inflammation, and glaucoma. The level of preoperative
iritis ranged from mild (1+ cells, 1+ flare) to severe (3+ cells, 2+ flare). BenEzra and Cohen
11
did not report the use of preoperative systemic or topical corticosteroid or other
immunosuppressive treatment in any children. Following surgery, each patient received a
retroorbital bolus of methylprednisone and an intravenous bolus of hydrocortisone. Each patient
also received postoperative hourly topical corticosteroids for 1 week which was then tapered on
an individual basis to minimize the level of intraocular inflammation. The poor outcomes
reported in the study by BenEzra and Cohen may be due to lack of preoperative control of
inflammation.
The only early postoperative complication in our study was elevated intraocular pressure in
one eye. A possible mechanism for the elevated postoperative IOP is decreased trabecular
outflow secondary to previous trabecular meshwork damage. The most common postoperative
complication in this study was posterior capsular opacification.
10,11,12
Five of six (83%) eyes in
