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Inflammation control important in cataract patients with juvenile idiopathic arthritis-associated uveitis
Ophthalmic Surg Lasers Imaging. 2010;41(1):104-108.
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Outcomes of cataract surgery in patients with juvenile idiopathic arthritis-associated uveitis depend on strict control of inflammation, according to a study.
"Cataract management in patients with uveitis remains a challenge to surgeons and can be especially difficult in children due to the risk of amblyopia, the excessive postoperative inflammation seen in pediatric uveitic eyes, and the difficulty in controlling the intraocular inflammation," the study authors said.
The retrospective chart review included 10 eyes of seven patients with juvenile idiopathic arthritis-associated uveitis and complicated cataract. Mean patient age at the time of surgery was 16.3 years.
All patients received oral prednisolone 1 mg/kg and periocular posterior sub-Tenon injections of triamcinolone acetonide (20 mg/0.5 mL) 3 days before surgery. Oral prednisolone was tapered after surgery.
Seven eyes received a heparin surface modified IOL and three eyes received a foldable acrylic IOL. All 10 lenses were placed in the capsular bag.
Investigators performed follow-up examinations at 1 day, 3 days, 3 weeks, 3 months and 6 months.
Study data showed that visual acuity improved by more than two Snellen lines in all eyes. Seventy percent of eyes had visual acuity of 20/40 or better and 30% of eyes improved to 20/60. Two eyes had posterior capsule opacification and one eye had anterior capsular fibrosis.
Successful preoperative and postoperative management of inflammation hinged on systemic immunosuppression agents such as methotrexate, systemic corticosteroids and topical corticosteroids, the authors said.
One of the most difficult management decisions for the cataract surgeon is the treatment of cataracts in patients with juvenile idiopathic uveitis. For years we have been taught that an IOL is contraindicated in these patients due to the risk of increasing inflammation. In this study, excellent visual results were achieved and the IOLs were well tolerated. The keys to success were meticulous surgery and the aggressive suppression of inflammation preoperatively and postoperatively through the use of systemic immunomodulation. Patients who did not achieve 20/40 or better visual acuity were felt to have developed amblyopia, which suggests a more aggressive surgical management is indicated in these patients. Patients with juvenile idiopathic uveitis related cataracts can do well when treated aggressively and followed closely.
– Eric D. Donnenfeld, MD
OSN
Cornea/External Disease Board Member