Lam- Surgical management of cataracts in children with JRA uveitis
3
Introduction
Cataracts occur in 40-60% of patients with juvenile rheumatoid arthritis (JRA)-associated
uveitis, which can be attributed to chronic inflammation and corticosteroid use.
1,2,3,4
Intraocular
lens (IOL) implantation after cataract surgery in patients with JRA-associated uveitis is
controversial. Many postoperative complications after cataract surgery without IOL
implantation have been reported in patients with JRA-associated uveitis, including posterior
synechiae, retrolental membranes, chronic inflammation, glaucoma, hypotony, phthisis, and
macular edema.
5,6,7
Consequently, these children have usually been left aphakic after cataract
surgery, necessitating the use of aphakic spectacles or contact lenses.
Contact lenses are associated with substantial expense and poor compliance. Among
children, contact lens intolerance is reported to be 17 to 38%.
8,9
Intraocular lens implantation
would reduce the risk of bacterial keratitis in children who must wear contact lenses and are on
chronic corticosteroid therapy. Intraocular lenses would also eliminate difficult contact lens
fitting of patients who have band keratopathy. In addition, children are often intolerant of
aphakic spectacles because of weight and aniseikonia.
Few have reported favorable outcomes after cataract surgery with IOL in children with JRA-
associated uveitis, and long-term outcomes have not been reported.
10,11,12
As postoperative
inflammation is especially exuberant in children and postoperative outcome data are limited, IOL
placement has not been advocated after cataract surgery in children with JRA-associated
uveitis.
5,6,7,13
Probst and Holland reported favorable results in eight patients with JRA-associated uveitis
after phacoemulsification and posterior chamber IOL (PC IOL) implantation.
12
A final visual
acuity better than 20/40 was achieved in seven of eight patients. However, all three patients age
