Abstract
Purpose To systematically review the results of comparative studies of modern cataract surgery in pediatric uveitis with or without intraocular lens (IOL) implantation and to perform comparative meta-analyses to compare visual acuity outcomes and complication rates. Methods On 12 November 2020, we systematically searched the Cochrane Central, PubMed/MEDLINE, EMBASE, ClinicalTrials.gov, and all affiliated databases of the Web of Science. Two authors independently reviewed studies and extracted data. Studies were reviewed qualitatively in text and quantitatively with meta-analyses. Outcome measures were preoperative and postoperative best-corrected visual acuity (BCVA), inflammation control, and rates of postoperative complications. Results Ten studies of 288 eyes were eligible for review of which the majority were eyes with juvenile idiopathic arthritis-associated uveitis. Summary estimates revealed that the BCVA was better in pseudophakic eyes vs. aphakic eyes (1-year postoperative: −0.23 logMAR, 95% CI: −0.43 to −0.03 logMAR, P=0.027; 5-year postoperative: −0.35 logMAR, 95% CI: −0.51 to −0.18 logMAR, P=0.000036). Pseudophakic eyes had more visual axis opacification (OR 6.76, 95% CI: 2.73 to 16.8, P=0.000036) and less hypotony (OR 0.19, 95% CI: 0.04 to 0.95, P=0.044). Conclusions In modern era cataract surgery on eyes with pediatric uveitis with IOL implantation leads to satisfactory and superior visual outcomes and no differences in complication rates apart from an increased prevalence of visual axis opacification and a decreased prevalence of hypotony when compared to aphakia. However, limitations of the retrospective design and the presence of selection bias necessitate a careful interpretation.
Highlights
Pediatric uveitis is a challenging condition with an annual incidence of 4.3–6.9 per 100.000 children under the age of 16 years [1–3]. e condition often has an asymptomatic course and children tend to underreport visual changes resulting in advanced disease at the time of diagnosis [4, 5]
Artigas et al [30] did not report visual acuity but found that Intraocular lens (IOL) implantation leads to more frequent visits due to PCO and glaucoma development compared to aphakia [30]. e authors conclude that these visits should be taken into consideration when planning surgery [30]
O’Rourke et al [34] found that IOL implantation leads to excellent visual acuity but that comorbidities such as glaucoma, band keratopathy, and cystoid macula edema (CME) all required a tight postoperative care and that 80% of eyes had uveitis flare-ups [34]. ey left one eye aphakic due to preexisting advanced uveitic glaucoma and difficulties in satisfactory immunosuppression; this eye did not improve in best-corrected visual acuity (BCVA) [34]
Summary
Pediatric uveitis is a challenging condition with an annual incidence of 4.3–6.9 per 100.000 children under the age of 16 years [1–3]. e condition often has an asymptomatic course and children tend to underreport visual changes resulting in advanced disease at the time of diagnosis [4, 5]. E purpose of this study was to systematically review the results of comparative studies of modern cataract surgery in pediatric uveitis with or without IOL implantation and conduct meta-analyses to summarize and compare important outcomes. Secondary outcomes were defined as specific incidence of the following within 5 years: anterior chamber inflammation, need for topical steroids, need for systemic immunosuppressive treatment, glaucoma (using the authors definition) or ocular hypertension, hypotony, need for resurgery for any reason, need for IOL explantation, visual axis opacification (posterior capsular opacification (PCO) and pupillary membrane formation), synechiae, phthisis bulbi, cystoid macular edema (CME), and retinal detachment. Erefore, quality of eligible studies was assessed using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool as recommended by Cochrane Methods [25, 26]. P values below 0.05 were interpreted as statistically significant
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