Controversies in intraocular lens implantation in pediatric uveitis.

Sumita Phatak,Carlos Pavesio,Careen Lowder

doi:10.1186/s12348-016-0079-y

Abstract

Cataract is one of the most common and visually debilitating complications of pediatric uveitis. It develops as a consequence of chronic inflammation and steroid use and is seen most often in juvenile idiopathic arthritis (JIA)-associated uveitis. Cataract extraction with intraocular lens (IOL) insertion has been carried out with a measure of success in non-uveitic pediatric eyes, but in cases of uveitis, multiple factors affect the final outcome. Chronic inflammation and its sequelae such as band keratopathy, posterior synechiae, and cyclitic membranes make surgical intervention more challenging and outcome less certain. Postoperative complications like increased inflammation, glaucoma, posterior capsular opacification, retrolental membranes, and hypotony may compromise the visual outcome. Early refractive correction is imperative in pediatric eyes to prevent amblyopia. The use of contact lenses and intraocular lenses in pediatric uveitic eyes were fraught with complications in the past. Surgical interventions such as vitreo-lensectomy followed by contact lens fitting and small incision cataract surgery followed by different types of intraocular lenses have been utilized, and many reports have been published, albeit in small patient groups. This review analyzes and discusses the existing literature on intraocular lens implantation in cases of pediatric uveitic cataract surgery.

Highlights

It is important to detect inflammation in the eyes of children because the sequelae anatomically change the eye and, as in the case of pediatric uveitic cataract, lead to sensory amblyopia and squint, reducing the child’s visual potential
Pediatric cataract extraction in non-uveitic eyes has a set of wellestablished pre, intra, and postoperative rules that cannot be applied in uveitic cataracts
Results of cataract surgery in children without uveitis cannot be directly applied to uveitic eyes, which have the dual problem of inflammatory sequelae and management of primary cause of inflammation

Summary

Introduction

It is important to detect inflammation in the eyes of children because the sequelae anatomically change the eye and, as in the case of pediatric uveitic cataract, lead to sensory amblyopia and squint, reducing the child’s visual potential. Results of cataract surgery in children without uveitis cannot be directly applied to uveitic eyes, which have the dual problem of inflammatory sequelae and management of primary cause of inflammation. Factors resulting in poor prognosis and strategies for their prevention The factors to consider before planning cataract surgery in pediatric uveitic eyes are the following: the etiology of uveitis, patient age, grade of inflammation, preoperative visual acuity, current systemic and local therapy, and risk of amblyopia [8, 14].

Results

Conclusion