juvenile idiopathic arthritis-associated uveitis versus pseudophakic eyes of children with Long-term ocular complications in aphakic

Aim To evaluate the long-term follow-up of aphakic and pseudophakic eyes of children with juvenile idiopathic arthritis (JIA)-associated uveitis with a special interest in whether intraocular lens implantation increases the risk of developing ocular complications. Methods Data were obtained from the medical records of 29 children (48 eyes) with JIA-associated uveitis operated on for cataract before the age of 16 years from January 1990 up to and including March 2007. Main outcome measures were long-term postsurgical complications and visual acuity in aphakic and pseudophakic eyes of children with JIA-associated uveitis. Results The number of complications after cataract extraction including new onset of ocular hypertension and secondary glaucoma, cystoid macular oedema and optic disc swelling did not differ between aphakic and pseudophakic eyes. Moreover, no hypotony, perilenticular membranes and phthisis were encountered in the pseudophakic group. Better visual acuity was observed in the pseudophakic eyes up to and including 7 years of follow-up (p1⁄40.012 at 7 years of follow-up). No differences in the preoperative or adjuvant perioperative treatment with periocular or systemic corticosteroids were found between the two groups; however, significantly more children were treated with methotrexate in the pseudophakic group (p1⁄40.006). Conclusion With maximum control of perioperative inflammation and intensive follow-up, the implantation of an intraocular lens in well-selected eyes of children with JIA-associated uveitis is not associated with an increased risk of ocular hypertension, secondary glaucoma, cystoid macular oedema and optic disc swelling and showed better visual results up to and including 7 years after cataract extraction. Cataract is a frequent complication of paediatric uveitis and involves about half of the affected children. 2 The choice of an appropriate surgical technique is crucial for the visual outcome after cataract extraction because, previously, these eyes frequently became hypotonic after cataract surgery. In children with uveitis, handling the presurgical and postsurgical inflammation and dealing with uveitis-related complications make cataract surgery challenging. The presence of posterior synechiae and pupillary membrane formation may limit the surgical access. Several studies revealed favourable surgical and visual outcomes after the implantation of an intraocular lens in selected cases of juvenile idiopathic arthritis (JIA)-associated uveitis. Although the advantages of intraocular lens implantation are obvious for visual rehabilitation and amblyopia prevention, in JIA-associated uveitis it has been associated with poor visual outcome as a consequence of complications including hypotony, cyclitic or fibrous membrane formation, intraocular lens deposits, macular oedema and posterior synechiae. 13 In some cases, progressive intraocular damage from intractable uveitis, perilenticular (cocoon) or ciliary membrane formation resulted in the decision to explant the intraocular lens. The role of intraocular lens implantation in the development of secondary glaucoma, cystoid macular oedema, optic disc swelling and hypotony in paediatric uveitis is unknown. The purpose of our study was to evaluate the long-term follow-up of aphakic and pseudophakic eyes of children with JIA-associated uveitis with a special interest in whether intraocular lens implantation increases the risk of developing secondary glaucoma, cystoid macular oedema, optic disc swelling, perilenticular membrane formation and hypotony. METHODS A retrospective review of the medical records of children with JIA-associated uveitis who underwent cataract extraction at the Department of Ophthalmology, University Medical Center, Utrecht, The Netherlands, and at the Department of Ophthalmology, University Medical Center, Groningen, The Netherlands, between January 1990 and March 2007 was performed. Both centres combine a secondary and a tertiary referral function. The inclusion criteria were onset of uveitis and cataract extraction before the age of 16 years with a minimum follow-up after cataract extraction of 1 year. Exclusion criteria were cataract extraction after the age of 16, follow-up of <1 year and incomplete data. Included in this study were 48 eyes (29 children) with JIA-associated uveitis of whom 29 eyes were pseudophakic (polymethylmethacrylaat n1⁄45, acrylic n1⁄424) and 19 eyes were aphakic after cataract extraction. Cataract surgery was performed if the visual acuity was #20/50 (Snellen) or in the presence of interfering lens opacities. Before ocular surgery we attempted to eliminate the intraocular inflammation for a minimum of 3 months. The date of the first and last included operated eye was April 1991 and March 2007 for the pseudophakic group and March 1990 and February 2002 for the aphakic group, respectively. During surgery, an anterior Department of Ophthalmology, University Medical Center Utrecht, The Netherlands Department of Ophthalmology, University Medical Center Groningen, University of Groningen, The Netherlands Correspondence to Karen M Sijssens, Department of Ophthalmology, University Medical Center Utrecht, E.03.136, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; [email protected] Accepted 1 November 2009 Published Online First 16 June 2010 Br J Ophthalmol 2010;94:1145e1149. doi:10.1136/bjo.2009.167379 1145 Clinical science group.bmj.com on September 10, 2010 Published by bjo.bmj.com Downloaded from