Surgical management of cataracts in children with juvenile rheumatoid arthritis-associated uveitis.
OBJECTIVE
To evaluate outcomes of cataract surgery with posterior chamber intraocular lens (IOL) implantation with or without trabeculectomy in children with juvenile rheumatoid arthritis (JRA)-associated uveitis.


METHODS
Interventional case series.


METHODS
Retrospective chart review of five patients aged 12 years or younger with JRA-associated uveitis who underwent cataract surgery with posterior chamber IOL with or without trabeculectomy at the Cleveland Clinic Foundation from December 1995 to October 2001.


RESULTS
Four female patients and one male patient ranging from age 7 to 12 years were identified. One patient had bilateral involvement; six eyes were included in the study. Three eyes underwent cataract extraction with posterior chamber IOL, and three underwent combined cataract surgery with posterior chamber IOL and trabeculectomy. Median age at surgery was 8.5 years, with a median follow-up of 43.5 months. Four of five children (five eyes) were on systemic methotrexate immunosuppressive therapy for a median length of 1.25 years before surgery. Two of five patients (three eyes) were also on additional systemic immunosuppressive or anti-inflammatory treatments. All eyes received frequent topical corticosteroid therapy for a median of 2 weeks preoperatively and 8.5 weeks postoperatively. A final postoperative Snellen visual acuity of 20/40 or better was achieved in all children. A median final visual acuity improvement of 7 Snellen lines was observed after cataract surgery.


CONCLUSIONS
With adequate long-term preoperative and postoperative control of intraocular inflammation with systemic immunosuppressive therapy in addition to intensive topical corticosteroid treatment, children with JRA-associated uveitis can demonstrate favorable surgical outcomes after cataract surgery with posterior chamber IOL.
Lam
Linda A
LA
Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Lowder
Careen Y
CY
Baerveldt
George
G
Smith
Scott D
SD
Traboulsi
Elias I
EI
D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000150:complications* / Q000188:drug therapy; D019923:Capsulorhexis; D002386:Cataract / Q000209:etiology*; D002648:Child; D005260:Female; D005901:Glaucoma / Q000209:etiology / Q000601:surgery; D005938:Glucocorticoids; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D019654:Lens Implantation, Intraocular; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D018918:Phacoemulsification; D011239:Prednisolone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012189:Retrospective Studies; D014130:Trabeculectomy; D016896:Treatment Outcome; D014605:Uveitis / Q000188:drug therapy / Q000209:etiology*; D014792:Visual Acuity
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; C009935:prednisolone acetate; D011239:Prednisolone; D008727:Methotrexate