Lam- Surgical management of cataracts in children with JRA uveitis
8
of Elschnig pearls and remains 20/20 at last follow-up. One eye with a history of macular edema
prior to surgery had cystoid macular edema after cataract surgery (Eye 3). Two eyes later
developed glaucoma that required subsequent filtering surgery (Eyes 2, 3). Eye 2 developed
elevated IOP (28 mmHg) at 37 months after surgery, while eye 3 developed elevated IOP (41
mmHg) at 20 months after surgery. Posterior synechia was not found in any eye at final follow-
up.
In the three patients who had concurrent filtering surgery at the time cataract surgery with PC
IOL, the median pre-operative IOP was 30 mmHg (range, 28 to 32 mmHg). The median number
of glaucoma medications used in these three patients was three (range, 3 to 4). The median post-
operative IOP in these three patients was 20 mmHg (range, 9 to 22 mm Hg), with a median of
one glaucoma medication used.
A best-corrected postoperative Snellen visual acuity of 20/40 or better (range 20/20 to 20/40)
was achieved in all 6 eyes (Table 1), with a median of 7 (range 3 to 10) lines of improvement.
Discussion
Cataract surgery with IOL is an accepted practice in the management of cataracts secondary
to many forms of uveitis, including Fuchs heterochromic iridocyclitis, lens-induced uveitis,
sarcoidosis, and nongranulomatous uveitis syndromes.
3,9,14
Several reports advocate against IOL
implantation in patients with JRA, because poor surgical outcomes have been documented in
eyes with JRA-associated uveitis after cataract surgery without IOL implantation.
3,5,6,7,13,15,16
Only 56% of these aphakic eyes had a best corrected visual acuity better than 20/60
7
or 20/70.
15
Systemic immunosuppression was not routinely used.
7,15
We reported better visual outcomes and fewer postoperative complications in five children
