Lam- Surgical management of cataracts in children with JRA uveitis
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Cataract surgery was performed using a continuous capsulorrhexis followed by
phacoemulsification or aspiration alone and placement of a PC IOL into the capsular bag. Four
eyes received a PMMA lens, and one received an acrylic lens. A trabeculectomy with
mitomycin-C (MMC) or 5-fluorouracil (5-FU) was also performed at the time of cataract surgery
in three eyes with glaucoma recalcitrant to medical treatment. (Eyes 4, 5, 6).
All patients were treated with an intensive postoperative regimen of topical corticosteroid
therapy (range, every hour or every other hour) for a median duration of 8.5 weeks (median 7.5,
range 2 to 11 weeks), followed by a tapering regimen to the patient's individual baseline topical
corticosteroid usage (Tables 2,4). The median time required postoperatively to reach baseline
corticosteroid usage was 11.5 weeks. The degree of postoperative anterior chamber
inflammation was recorded at 1 week, 6 weeks, 3 months, 6 months, and one year (Table 3).
Postoperatively, all children except Patient C were continued on a regimen of systemic
immunosuppressive therapy similar to that used preoperatively (Table 2). Patients A and B were
given a longer course of oral prednisone postoperatively.
The only early postoperative complication was an elevated IOP at postoperative day 1 (52
mmHg) in one eye that required both oral and topical medications to reduce the IOP (Eye 2).
Later postoperative complications (Table 5) after cataract surgery included posterior capsular
opacification (5), glaucoma (3), Elschnig pearl formation (1), and cystoid macular edema (1).
Five of six eyes that underwent intraocular lens implantation required one Nd:YAG capsulotomy
procedure for posterior capsular opacification . The median duration between cataract surgery
and Nd: YAG capsulotomy was 7 months (mean 11.6, range 2 to 33 months). No eye required a
second Nd: YAG capsulotomy, although one eye (Eye 5) underwent posterior capsulectomy
and vitrectomy 3 years after initial Nd:Yag capsulotomy for removal of excessive proliferation
