ABSTRACT
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 (p=0.012 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 (p=0.006). 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.
Subject(s)
Aphakia/complications , Arthritis, Juvenile/complications , Lens Implantation, Intraocular/adverse effects , Pseudophakia/complications , Uveitis/etiology , Cataract Extraction/adverse effects , Child , Child, Preschool , Female , Glaucoma/etiology , Humans , Infant , Lenses, Intraocular , Macular Edema/etiology , Male , Ocular Hypotension/etiology , Papilledema/etiology , Retrospective StudiesABSTRACT
Two girls, aged 8 and 13 years, with a history of arthritis presented with already advanced uveitis. Neither girl had been screened for uveitis by an ophthalmologist according to the recommendations of the American Academy of Pediatrics. Both patients had extensive posterior synechiae (adhesions between lens and iris) at their first ophthalmologic examination, which is associated with an unfavourable prognosis. At the last follow-up, the first patient had undergone seven ocular operations: five for glaucoma and two cataract surgeries. Uveitis occurs in 20% of children with juvenile idiopathic arthritis. The visual outcome of uveitis is negatively influenced by the presence of ocular complications at the first ophthalmologic examination. Ophthalmologic screening of children with juvenile idiopathic arthritis is very important because it is a common cause ofuveitis in childhood, the uveitis is usually asymptomatic, and there are sight-threatening complications. Screening is always important, even when the arthritis is in remission.
