Lam- Surgical management of cataracts in children with JRA uveitis
5
(ANA) status, angiotensin converting enzyme (ACE), and HLA-B27 seropositivity, were also
recorded.
Results
Five children (four female, one male) age 12 or younger with JRA-associated uveitis
underwent cataract surgery with PC IOL implantation between December 1995 and October
2001 (Table 1). One patient underwent bilateral cataract surgery (Patient B). All five children
(six eyes) were included in this study. Three eyes underwent cataract surgery with PC IOL
implant, and three eyes had combined cataract surgery with PC IOL and trabeculectomy.
Median age at surgery was 8.5 years (mean 9, range 7 to 12 years). Median length of follow-up
was 43.5 months (mean 43.7, range 17 to 69).
A pediatric rheumatologist established the diagnosis of JRA in all cases. All patients had a
positive ANA test. Two patients had elevated ACE levels, using reference values appropriate
for their ages (Patients C and E). Patient E also had a positive HLA-B27 test.
The median length of uveitis before cataract surgery was 3 years (mean 4.7, range 1.5 to
10.75 years). Band keratopathy was found in four of six eyes, and was vision-limiting in one eye
(Eye 2) that underwent EDTA chelation 7 months before cataract surgery. All six eyes had
anterior uveitis. Preoperative posterior synechiae were found in three eyes (Eyes 2, 4, 5). All six
eyes had moderate to severe posterior subcapsular cataracts and vision of 20/100 or less. Eye 1
also had a dense cortical cataract. Two eyes had cystoid macular edema prior to surgery (Eyes 2
and 3). Glaucoma was present in three of six eyes prior to cataract surgery, and all three
underwent combined trabeculectomy and cataract surgery with PC IOL (Eyes 4, 5, 6). The
median period between the development of uveitis and the onset of glaucoma in these three eyes
was 0.5 years (range, 0.25 to 1.67 years).
