Lam- Surgical management of cataracts in children with JRA uveitis
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Lundvall and Zetterstrom
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with the worst postoperative vision was in the only child who did not
receive systemic corticosteroid or immunosuppressive therapy.
10
This child subsequently
underwent five additional operations for secondary membranes, and developed glaucoma,
macular edema, and severe band keratopathy.
Our study is limited by small sample size, lack of controls and relatively short duration of
follow-up, when one considers the potential duration of uveitis. Longer-term results at 5 and 10
years postoperatively may reveal whether other complications develop as these children age.
Nevertheless, our series presents good outcomes at the longest durations of follow-up reported to
date. A multicenter collaborative study with standardized preoperative immunosuppressive
therapy and IOL lens type would allow further assessment of outcomes in a larger pediatric
population but it is unlikely that such a study will be performed.
Our results support the notion that selected children with JRA-associated uveitis can have
stable, favorable visual results following cataract surgery with PC IOL. Intraocular lens
implantation reduces the risk of amblyopia, corneal infections, and compliance problems that
accompany the use of contact lenses in children. We believe that long-term pre- and
postoperative control of inflammation with immunosuppressive agents supplemented by
aggressive topical or systemic corticosteroid therapy or both is essential for achieving favorable
outcomes after cataract surgery with implantation of IOL in selected children with JRA-
associated uveitis.
