Controlling inflammation key for cataract surgery in children with uveitis

NASHVILLE, Tenn. — The keys to success in cataract surgery in children with uveitis are making sure the inflammation stimulated by surgery is controlled properly and being prepared with a medication plan, according to a speaker here.

“Our roles as ophthalmologists in uveitis is to minimize complications, treat aggressively, control inflammation and reduce the need for topical steroids, but we all know that complications still happen,” Stefanie L. Davidson, MD, said at the American Association for Pediatric Ophthalmology and Strabismus meeting.

Stefanie L. Davidson

Removal of band keratopathy, cataract surgery and glaucoma surgery are the three most common surgeries recommended in the uveitis clinic, Davidson said.

The more common complication is cataract, occurring in up to 20% of patients with JIA, according to Davidson.

“Generally the surgery is indicated for vision below 20/50, but that’s not the hard part,” she said. “It’s easy to cite when somebody needs cataract surgery, but how do you plan for it? What refractive choice do you make for them? And how are you going to manage their inflammation afterward?”

In aphakic cases, glasses are a problem if surgery is unilateral, and compliance with contact lens wear can be poor. But, IOL placement is also controversial, Davidson said.

“The biggest concern is that the presence of the IOL puts the patient at risk for developing cyclitic membrane, posterior synechiae, hypotony and phthisis, glaucoma and macular edema,” she said.

Since the advent of biologics and systemic medications that control uveitis, however, some physicians are confident in placing IOL in these cases.

“The take-home message is that the eye should be quiet without any cell for at least 3 months prior to surgery,” she said.

“Definitely coordinate with the rheumatologist,” she said. – by Patricia Nale, ELS

Reference:

Davidson S. Surgical considerations for uveitis patients. Presented at: American Association for Pediatric Ophthalmology and Strabismus annual meeting; April 2-6, 2017; Nashville, Tenn.

Disclosure: Davidson reports no relevant financial disclosures.