Lam- Surgical management of cataracts in children with JRA uveitis
2
Abstract
Purpose: To evaluate outcomes of cataract surgery with posterior chamber intraocular lens
implantation (PC IOL) with or without trabeculectomy in children with juvenile rheumatoid
arthritis (JRA)-associated uveitis.
Design: Interventional case series.
Methods: Retrospective chart review of 5 patients aged 12 years or younger with JRA-
associated uveitis who underwent cataract surgery with PC IOL with or without trabeculectomy
at The Cleveland Clinic Foundation from December 1995 to October 2001.
Results: Four female and one male patients, ranging from age 7 to 12 years were identified.
One patient had bilateral involvement; 6 eyes were included in the study. Three eyes underwent
cataract extraction with PC IOL, while 3 underwent combined cataract surgery with PC IOL and
trabeculectomy. Median age at surgery was 8.5 years, with a median follow-up of 43.5 months.
Four of 5 children (5 eyes) were on systemic methotrexate immunosuppressive therapy for a
median length of 1.25 years before surgery. Two of five patients (3 eyes) were also on
additional systemic immunosuppressive or anti-inflammatory treatments. All eyes received
frequent topical corticosteroid therapy for a median of 2 weeks preoperatively and 8.5 weeks
postoperatively. A final postoperative Snellen visual acuity of 20/40 or better was achieved in
all children. A median final visual acuity improvement of 7 Snellen lines was observed after
cataract surgery.
Conclusion: With adequate long-term pre- and postoperative control of intraocular
inflammation with systemic immunosuppressive therapy in addition to intensive topical
corticosteroid treatment, children with JRA-associated uveitis can demonstrate favorable surgical
outcomes following cataract surgery with PC IOL.
