Implantation of intraocular lens in children with uveitis : long term visual outcome and prognosis

Abstract

Abstract Purpose To evaluate long term visual acuity, intra ocular inflammation and late complications for children with chronic uveitis who underwent cataract surgery with posterior chamber intra ocular lens (IOL) implantation. Methods Retrospective, monocentric study of children under 16 with chronic uveitis and who underwent cataract surgery between january 1996 and december 2001. Surgical protocol included : phacoaspiration with posterior capsulorhexis, anterior vitrectomy and IOL implantation. Visual acuity, intra ocular pressure, slight lamp examination, laser flare photometry and anti inflammatory treatment were analyzed at different time points. Results 17 eyes of 12 children (8 boys, 4 girls) were included. Uveitis was bilateral in 6 cases. The mean age at surgery was 10.5 years (ranged from 4 to 15) and the mean follow up time was 8.9 years (from 7 to 13). Diagnosis of uveitis was idiopathic juvenile arthritis in 8 cases (64.7%), sarcoidosis in 1 case and finally no etiology was identified in 3 cases (29.4%). Seven years after surgery, the mean visual acuity was 0.33 logMAR and 82% of children had still an immuno modulatory treatment. Late complications were : glaucoma (11.7%) , Elschnig perls (11.7%) , giant cells on IOL (35%) and CME (6%) of cases. Conclusion IOL implantation in children with chronic uveitis prevents amblyopia and allows rapid visual recovery. Complete surgical procedure in this group of children has interesting results on visual acuity and rehabilitation. Strict and long‐term control of intraocular inflammation is mandatory in order to prevent major complications and blindness. Implantation should not be proposed in young children with JIA‐associated uveitis.