Surgery for hypotony in patients with juvenile idiopathic arthritis-associated uveitis.
OBJECTIVE
To describe the clinical response to cyclitic membrane excision of eyes with juvenile idiopathic arthritis (JIA)-associated uveitis and hypotony.


METHODS
The clinical records of patients with JIA-associated uveitis in a tertiary referral center were reviewed. Those patients with JIA-associated uveitis and hypotony who underwent cyclitic membrane excision were included in the study. Patients with hypotony secondary to active inflammation, retinal detachment, and surgical intervention (filtering, cyclo-destructive procedures, and glaucoma valve implantation) were excluded.


RESULTS
Two pediatric and two adult patients (4 eyes) were identified. The range of pre-operative intraocular pressure (IOP) was 0-5 mmHg. The two adult patients were noted to have atrophic ciliary processes intra-operatively, while the two pediatric patients had normal ciliary processes. At six months follow-up, the adult patients had IOPs of 5 mmHg, while the two pediatric patients had IOPs of 16 mmHg. At last consultation (mean duration of follow-up: 3.6 years), IOP was normal in all eyes. None of the eyes had a decrease in vision.


CONCLUSIONS
Release of traction on the ciliary body by inflammatory membranes may play a role in the management of hypotony in patients with JIA-associated uveitis. However, even though the IOP was successfully elevated, preventing phthisis, vision remained poor due to the long-standing complications secondary to chronic uveitis. This emphasizes the critical importance of early diagnosis and appropriate treatment of the inflammation before vision-robbing complications occur.
Yu
Ellen N
EN
Massachusetts Eye Research & Surgery Institute, Ocular Immunology and Uveitis Foundation, Harvard Medical School, Cambridge, MA 02142, USA.
Paredes
Ian
I
Foster
C Stephen
CS
D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000150:complications* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007429:Intraocular Pressure / Q000502:physiology*; D008727:Methotrexate / Q000627:therapeutic use; D015814:Ocular Hypotension / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012599:Sclerostomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014605:Uveitis / Q000150:complications* / Q000188:drug therapy; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
D018501:Antirheumatic Agents; D007155:Immunologic Factors; D003520:Cyclophosphamide; D008727:Methotrexate