Intraocular Lens Implantation in Patients with Juvenile Idiopathic Arthritis-Associated Uveitis

Abstract

Objective: To evaluate the development of cataract and the results of cataract surgery with intraocular lens (IOL) implantation in patients with chronic uveitis associated with juvenile idiopathic arthritis (JIA). Patients and Methods: A hospital-based retrospective case series consisted of 25 patients with JIA-associated uveitis. The mean age of the patients was 5.8 years at the onset of arthritis and 6.8 years at the onset of uveitis. During the 15-year study period cataract surgery with implantation of an IOL was performed in 36 eyes. In 17 eyes phacoemulsification and initial posterior capsulectomy with anterior core vitrectomy were performed. The treatment of JIA and uveitis was carefully adjusted with systemic immunosuppressive drugs and topical corticosteroids perioperatively. The mean postoperative follow-up period was 3.3 years. Results: The first signs of cataract were observed 2.3 years (mean) after the diagnosis of uveitis and the cataract operation of the first eye was performed 4.5 years (mean) after the diagnosis of uveitis. After IOL surgery the visual result was good (≧0.5) in 64%, moderate (0.3 to <0.5) in 11% and impaired (<0.3) in 25% of eyes. Secondary cataract developed in 16 eyes but in none of the eyes with initial posterior capsulectomy and core vitrectomy. Secondary glaucoma developed in 18 eyes, retinal detachment in 2, cystoid macular edema in 16 and band keratopathy in 12 eyes. Conclusion: Cataract is an early complication of JIA-associated uveitis. Under strict control of uveitis, IOL implantation is an important alternative in visual rehabilitation for this type of patient.