April 09, 2007
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IOL implantation safe for pediatric uveitis patients, study finds

Patients with pediatric uveitis, including uveitis associated with juvenile rheumatoid arthritis, can safely undergo IOL implantation, a study found. The results suggest that IOL implantation should no longer be considered a contraindication in pediatric uveitis, the study authors noted.

Pediatric uveitis represents 5% to 10% of all uveitis cases. Children with uveitis, especially those with uveitis related to juvenile rheumatoid arthritis (JRA), who undergo cataract surgery are at added risk of surgical complications because of active inflammation, band keratopathy and small pupils, the authors reported.

Arie Y. Nemet, MD, of Sapir Medical Center, Kfar-Saba, Israel, and colleagues conducted a multicenter, retrospective, interventional case series examining the visual outcomes and postoperative complications after cataract surgery with posterior chamber IOL implantation in children with uveitis. They published their results in the March issue of Archives of Ophthalmology.

The study included 19 eyes of 18 children treated with cataract surgery and IOL implantation. This included 10 children with JRA and eight children without JRA.

Researchers treated the children's inflammation for 3 months preoperatively and administered dexamethasone phosphate and systemic corticosteroids for up to 10 days before surgery.

Intraoperatively, surgeons combined posterior capsulotomy with core anterior vitrectomy when required. Each child received either a PMMA lens inserted through a limbal incision or a foldable hydrophobic or hydrophilic acrylic IOL inserted through a 3.2-mm corneal incision, according to the study.

Postoperatively, each child received topical corticosteroids eight times daily and 1% atropine sulfate twice daily for 1 week. Follow-up averaged 3.4 years for the JRA group and 4.6 years the non-JRA group.

Best corrected visual acuity ranged from 20/70 to light perception preoperatively and improved to 20/20 to 20/200 after surgery. All eyes showed an improvement in visual acuity of at least two lines, and 13 eyes had final visual acuity of 20/40 or better, according to the study.

Intraocular inflammation remained in seven eyes after surgery, including three in the JRA group. Posterior capsular opacification represented the most common complication, seen in 11 eyes, the authors noted.