Lam- Surgical management of cataracts in children with JRA uveitis
9
with JRA-associated uveitis after cataract surgery with PC IOL compared to previous
studies.
10,11,12
We believe that the key factor in postoperative success in our patients was
aggressive control of pre- and postoperative intraocular inflammation. Four of five children in
this study were on systemic immunosuppression in addition to topical corticosteroid therapy
before and after surgery.
Probst
and
Holland
12
reported favorable surgical outcomes after phacoemulsification with PC
IOL implantation in seven patients with JRA-associated uveitis, but the postoperative results in
the three children aged 13 or younger were inferior to those in the adult patients. These three
eyes developed persistent postoperative inflammation, posterior synechiae, and pupillary
membranes. No systemic immunosuppressive agents other than corticosteroids were given. For
five days preoperatively and for an unspecified duration postoperatively, topical corticosteroids
were given at a frequency ranging from four times daily to hourly. These eyes also received
intraoperative subconjunctival corticosteroids. In contrast, the pediatric eyes in the current study
did not demonstrate any postoperative posterior synechiae, pupillary membranes, or persistent
postoperative inflammation. We believe that the lack of such complications may be attributed to
the use of aggressive systemic methotrexate and corticosteroid immunosuppression. Four of five
children in this study underwent systemic immunosuppression for a median length of 1.25 years
prior to eye surgery.
Lundvall
and
Zetterstrom
10
reported 7 children with uveitis and positive ANA tests aged 10
or younger (10 eyes), who underwent cataract surgery with implantation of a heparin-surface
modified PMMA PC IOL. Pre- and postoperative systemic corticosteroids or methotrexate or
both were used in all children except one. No specific information was provided as to the pre-
and postoperative duration, dosage, or frequency of topical or oral corticosteroid or methotrexate
