Lam- Surgical management of cataracts in children with JRA uveitis
6
All eyes were being treated with topical corticosteroid therapy (prednisolone
acetate 1%) chronically to suppress iritis. Topical corticosteroid therapy was started at the time
of diagnosis of iritis with a median length of 3 years of treatment before surgery (mean 4.7 years,
range 1.5 to 10.75 years).
Four of five children (five eyes) were on systemic methotrexate therapy for a median of 1.25
years (mean 2.5, range 0.75 to 6.17 years) prior to surgery (Table 2). The median dose was 13.5
mg weekly (mean 13.2, range 10-15 mg). Two of five patients (three eyes) were on additional
systemic immunosuppressive or anti-inflammatory therapy (Table 3) such as hydrochloroquine
(Plaquenil
, Sanofi-Winthrop Pharmaceuticals, NY, NY), auranofin (Ridaura
, SK Beecham,
Philadelphia, PA), prednisone (Deltasone
, Upjohn, Kalamazoo, MI), and naproxen (Naprosyn
,
Roche, Nutley, NJ).
In all patients, preoperative topical corticosteroid therapy was adjusted on an individual basis
to obtain the minimum achievable level of inflammation in each patient (range, four times daily
to hourly) for a median of 2 weeks (mean 3, range, 1 to 6 weeks) (Table 2). The degree of
preoperative iritis ranged from none to 1+ cells and 1+ flare (Table 3). Preoperatively all
patients continued to receive methotrexate or other systemic immunosuppressive therapy, or a
combination of these agents, except for Patient C, who did not receive any pre- or postoperative
systemic immunosuppressive therapy (Table 2).
Preoperatively all eyes demonstrated none or minimal signs of uveitis. All but one eye
demonstrated fewer than ½+ cells, while one eye had 1+ cells prior to surgery. Posterior
synechiae were lysed with the viscoelastic or cyclodialysis spatula prior to capsulorrhexis.
