Visual Outcome Of Cataract Surgery Research Articles

Monitoring and modernization to improve visual outcomes of cataract surgery in a community eyecare center in western India

To determine whether routine monitoring leads to better visual outcomes over time after cataract surgery. Comprehensive community eyecare center in western India. Comparative case series. Operative case sheets of all patients having cataract surgery were collected. Preoperative information, surgical details, and follow-up findings were included in the audit. The outcome measure was postoperative corrected distance visual acuity (CDVA), which was graded as good (≥ 6/18), borderline, or poor (<6/60). If the outcome was poor, the causes were classified as follows: selection, surgery, spectacles, or sequelae. The surgeons were briefed about their performance twice a year. The audit included 16,382 cataract surgeries. The proportion of eyes having a CDVA of 6/18 or better 6 weeks postoperatively improved significantly, from 86.5% (95% confidence interval [CI], 84.8%-88.3%) in 2002 to 90.5% (95% CI, 89.3%-91.8%) in 2005, while CDVA worse than 6/60 declined from 5.9% in 2002 to 2.5% in 2005. Manual small-incision cataract surgery was more popular than conventional extracapsular cataract surgery in 2004 and 2005. The incidence of posterior capsule tear and vitreous loss declined in the later years, although the rate of striate keratitis remained the same. Younger patients, women, those without ocular comorbidity, and those with a preoperative CDVA of better than 6/60 had better visual acuity 8 weeks postoperatively. Routine monitoring and modernization of technique helped increase good visual outcomes and reduce poor visual outcomes after cataract surgery.

Predicting the necessity of LASIK enhancement after cataract surgery in patients with multifocal IOL implantation

PurposeTo investigate if the parameters measured routinely prior to cataract surgery with multifocal intraocular lens (IOL) implantation can predict the necessity of additional laser in situ keratomileusis (LASIK) to improve visual outcome.MethodsRecords of patients undergoing cataract surgery between January 2008 and December 2009 were reviewed. Individuals satisfied with visual outcome of cataract surgery and not satisfied were grouped (group 1 and 2, respectively). Preoperative data of refractive error, axial length, corneal astigmatism, intraocular pressure, and postoperative uncorrected visual acuity were recorded. Data was available for 62 patients (104 eyes), of which LASIK enhancement was deemed necessary in 21 eyes (20%; group 2). The receiver operator characteristic curves were used to discriminate between the groups and linear regression analysis was performed to predict the postoperative visual outcome.ResultsThe astigmatism measured preoperatively using manifest refraction had an accuracy of 64% in discriminating between the groups. Age, spherical component of refraction, axial length, corneal astigmatism, and intraocular pressure were very close to chance prediction 59%, 57%, 56%, 51%, and 51%, respectively. The postoperative uncorrected visual acuity had an accuracy of 79% in discriminating the groups. Individuals with uncorrected visual acuity worse than 20/40 after cataract surgery were most likely to undergo LASIK enhancement; however, approximately 20% of group 2 underwent LASIK enhancement despite having visual acuity of 20/30 or better. When combined, preoperative visual acuity accounted for just 7% of variance in postoperative uncorrected visual acuity.ConclusionRequirement of LASIK enhancement after cataract surgery with multifocal IOL implant is complex in nature, and parameters routinely measured before surgery cannot successfully identify the group requiring LASIK enhancement or predict postoperative uncorrected visual acuity.

Screening of cataract surgery in four rural populations aged 50 years old and above in western China

To estimate the cataract surgical coverage and cataract surgery rate and to assess the visual outcome of cataract surgery among individuals aged at or over 50 years old in four rural populations from four different areas of western China. This cross-sectional study, performed during the period 2003 - 2005, used the method of cluster sampling and recruited 5562 persons aged 50 years old or above through household census. Standardized ocular examinations including visual acuity test, intraocular pressure measurement, slit-lamp and fundus examination were performed. The main outcome criteria were cataract surgical coverage, cataract surgery rate, complication rate and visual outcome after cataract surgery. Of individuals with bilateral presenting visual acuity < 6/60 due to age-related cataract, the cataract surgical coverage was 54% in Qinghai. It was the highest among these four populations. The highest cataract surgery rate (CSR) value was 1551 in Qinghai and the lowest 143 in Guangxi during the period of 2000-2002. The overall intraocular lens implantation rate was 51.5% in 200 eyes with cataract surgery and 40.5% eyes with post-operative visual acuity < 6/60. The overall post-operative complication rate was 28%. In the beginning of 21st century, the cataract surgical coverage in four rural populations aged 50 years old or above in western China was low and similar to the situation of the last decade in eastern China. Cataract surgical technique and low IOL implantation rate are the main causes for a poor visual outcome. To reduce the risks of cataract blindness, the clinicians should substantially improve the visual outcome as well as the number of cataract surgery.

Functional visual outcomes of cataract surgery in patients with 20/20 or better preoperative visual acuity

To measure the visual outcomes after cataract surgery in patients with 20/20 or better preoperative visual acuity. University-based cataract referral practice. In this retrospective case review, 2 groups of patients with a corrected distance visual acuity (CDVA) of 20/20 or better in both eyes before cataract surgery were identified. Patients in the first group had a cataract in 1 eye and an intraocular lens (IOL) in the other eye. Patients in the second group had cataracts in both eyes. Each patient completed a Visual Function 14 (VF-14) questionnaire before and after cataract surgery. Changes in VF-14 scores were analyzed. The VF-14 scores improved significantly after cataract surgery in both groups. Patients with cataract in 1 eye and an IOL in the other eye before surgery (n = 28) had a mean improvement of 12.2 in the VF-14 score (P = .029). Patients with cataract in both eyes (n = 31) had a mean improvement of 14.5 in the VF-14 score (P<.0001). The functional vision of patients with 20/20 or better preoperative CDVA improved significantly after cataract surgery. This finding shows that arbitrary CDVA thresholds of worse than 20/20 cannot always be used to determine who will benefit from cataract surgery.

Cataract surgical outcomes in diabetic patients: Case control study

Purpose:To determine the visual outcome of cataract surgery in diabetes mellitus with advanced cataract in a tertiary institution in Nigeria.Design:A retrospective case control study conducted at the University College Hospital, Ibadan Nigeria.Subjects:Twenty three consecutive patients with diabetes and 23 age and sex matched non-diabetic control patients who had extracapsular cataract extraction for advanced cataract between 2002-2005.Main outcome:Mean post operative visual acuity and surgical complications.Results:Twenty three patients with diabetes mellitus and 23 non diabetic controls were studied; mean duration of diabetes was 8.1 ± 7.2 years. The mean post operative visual acuity in diabetics was 0.11±0.38, 0.33±0.57 and 0.38±0.49 at one week, two months and six months compared with 0.23±0.19, 0.46±0.37 and 0.48±0.31 in non diabetics. (p=0.207, 0.403 and 0.465 respectively). Improvement in preoperative visual acuity was noted in 84.2% and 90% in diabetics and non-diabetics respectively. Poor visual outcome in diabetics was mainly due to diabetic retinopathy, maculopathy or diabetes related surgical complications.Conclusion:Visual improvement was seen following surgery for advanced cataract in diabetics in this study population. Post operative monitoring for treatment of diabetic retinopathy may enhance visual outcome.

Prevalence of cataract surgery and post-surgical visual outcomes in an urban Asian population: the Singapore Malay Eye Study

Aim:The aim of the study was to describe the prevalence and visual outcomes of cataract surgery in an urban Asian population.Methods:This was a population-based study of 3280 Singapore Malays aged...

Cataract surgery for the developing world

To review surveys published within the last year concerning the prevalence of cataract blindness, rates of cataract surgical coverage and visual outcomes of cataract surgery in various developing countries, and to review recent studies that compare the different cataract surgical techniques used in developing countries. Up to 75% of blindness (visual acuity below 20/400) is due to cataract. Cataract remains the most common treatable cause of blindness. Reported cataract surgical coverage is low, and visual outcomes are poor and necessitate improvement. Phacoemulsification is the preferred technique for cataract surgery in developed countries, but large-scale implementation in developing countries may prove to be a challenge. An alternative surgical technique, manual sutureless small incision extracapsular cataract surgery, has been increasing in popularity, as the technique has been shown to yield similar surgical outcomes as phacoemulsification. Treating cataract blindness worldwide continues to be a formidable challenge. Significant barriers include cost, lack of population awareness, shortage of trained personnel and poor surgical outcomes. Both phacoemulsification and manual small incision extracapsular cataract surgery achieve excellent visual outcomes with low complication rates, but manual small incision extracapsular cataract surgery is significantly faster, less expensive and requires less technology. Therefore, manual small incision extracapsular cataract surgery may be the preferred technique for cataract surgery in the developing world.

Visual Outcomes of Cataract Surgery in a Rural Population of South India: Results from a Population-Based Survey

We aimed to assess the outcomes of cataract surgery in a rural population of south India. A house-to-house survey was carried out in 15 villages. Out of the 156 eyes operated on for cataract, the outcome was good, borderline and poor in 49.3%, 35.2% and 14.1% of the eyes respectively. There is a need to focus on the quality of cataract surgical services rather than just the number of cataract surgeries to reduce the burden of cataract blindness.

Cataract Surgery in the Small Adult Eye

Microphthalmos is a rare condition that is often associated with several other ocular abnormalities. Given the considerable differences between microphthalmic and anatomically normal eyes, cataract surgery is technically demanding in these patients, and special attention must be given to adequate preoperative planning of these procedures. Furthermore, the unique nature of these surgeries creates a particular subset of intraoperative and postoperative complications. However, with the advent of piggyback intraocular lens placement, the visual outcomes of cataract surgery in small adult eyes have improved considerably over the past 20 years. This review discusses the nature of the microphthalmic eye, and addresses proper pre-, intra-, and postoperative care of the microphthalmic patient.

Incidence and management of cataract after retinal detachment repair with silicone oil in immune compromised patients with cytomegalovirus retinitis

Purpose To determine the incidence of and risk factors for cataract and to describe the visual outcomes of cataract surgery in eyes with cytomegalovirus-related retinal detachments repaired with silicone oil. Study design Retrospective cohort study. Methods A prospectively generated database of all patients with cytomegalovirus retinitis examined at a single tertiary care institution was used to identify all cases of retinal detachment between October 1983 and August 1997. Data on retinal detachment repair, development of cataract, and outcomes of cataract surgery were obtained retrospectively. Results Among 904 eyes of 587 immune-compromised patients diagnosed with cytomegalovirus retinitis, 198 eyes of 155 patients developed retinal detachment. Among these, 106 eyes of 90 patients underwent retinal detachment repair with silicone oil. The Kaplan-Meier estimated median time to cataract was 1.8 months after surgery with silicone oil. The adjusted relative risk of cataract in eyes that underwent retinal detachment repair with silicone oil compared with eyes that did not was 6.74 ( P < .0001). Eight of the eyes that developed cataract underwent uncomplicated cataract surgery by phacoemulsification and posterior chamber intraocular lens implantation. Among these, six eyes experienced ≥2 lines of improvement in visual acuity. All developed posterior capsule opacification a median of 7 days after cataract surgery. Four of five eyes that that underwent neodymium:yttrium-aluminum-garnet laser capsulotomy experienced ≥2 lines improvement in visual acuity. Conclusions There is a high incidence of cataract after surgery with silicone oil tamponade for cytomegalovirus-related retinal detachment. Posterior capsule opacification occurs rapidly after cataract surgery in these patients.

Visual outcome of cataract surgery in children with congenital rubella syndrome.

To evaluate visual outcome after cataract surgery in children with congenital rubella syndrome (CRS). A retrospective analysis was conducted on 40 eyes of 22 children with CRS who underwent cataract surgery. Thirty-six eyes underwent lensectomy with anterior vitrectomy, and 4 eyes underwent extracapsular cataract extraction with primary posterior capsulectomy. The median age at surgery was 6 months, and median duration of postoperative follow up was 68.5 months. Each follow-up visit consisted of visual acuity estimation, refraction, anterior and posterior segment examination, and intraocular pressure measurements. Visual acuity at final follow up was 6/24 or better in 6 (15.0%) eyes, and 22 (55.0%) eyes had visual acuity less than 3/60. Postoperative complications included transient corneal edema in 18 (45.0%) eyes, glaucoma in 5 (12.5%) eyes, after cataract in 1 (2.5%) eye, and hyphema in 1 (2.5%) eye. Ocular disorders affecting visual outcome included stimulus deprivation amblyopia, glaucoma, optic atrophy, corneal opacity, and after cataract. Associated systemic disorders included neurological problems in 15 (68.2%), hearing loss in 12 (54.6%), cardiovascular problems in 9 (40.9%), and speech abnormalities in 7 (31.8%) children. The less-than-optimal postoperative visual outcome suggests the need to look at primary prevention of rubella, especially in developing countries.

Visual outcome of cataract surgery in children with congenital rubella syndrome

Purpose To evaluate visual outcome after cataract surgery in children with congenital rubella syndrome (CRS). Methods A retrospective analysis was conducted on 40 eyes of 22 children with CRS who underwent cataract surgery. Thirty-six eyes underwent lensectomy with anterior vitrectomy, and 4 eyes underwent extracapsular cataract extraction with primary posterior capsulectomy. The median age at surgery was 6 months, and median duration of postoperative follow up was 68.5 months. Each follow-up visit consisted of visual acuity estimation, refraction, anterior and posterior segment examination, and intraocular pressure measurements. Results Visual acuity at final follow up was 6/24 or better in 6 (15.0%) eyes, and 22 (55.0%) eyes had visual acuity less than 3/60. Postoperative complications included transient corneal edema in 18 (45.0%) eyes, glaucoma in 5 (12.5%) eyes, after cataract in 1 (2.5%) eye, and hyphema in 1 (2.5%) eye. Ocular disorders affecting visual outcome included stimulus deprivation amblyopia, glaucoma, optic atrophy, corneal opacity, and after cataract. Associated systemic disorders included neurological problems in 15 (68.2%), hearing loss in 12 (54.6%), cardiovascular problems in 9 (40.9%), and speech abnormalities in 7 (31.8%) children. Conclusions The less-than-optimal postoperative visual outcome suggests the need to look at primary prevention of rubella, especially in developing countries.

Visual outcome of cataract surgery in children with congenital rubella syndrome

Visual outcome of cataract surgery in children with congenital rubella syndrome

Outcome and number of cataract surgeries in India: policy issues for blindness control.

To assess what impact attention to quality of cataract surgery and postoperative follow up can have on cataract blindness in India, and to estimate the number of surgeries needed to eliminate cataract blindness in India. In a population-based sample of 5268 persons in two rural areas in the state of Andhra Pradesh, India, data on the visual outcome of cataract surgery were obtained on 129 eyes of 106 persons operated previously. These were compared with the visual outcome of cataract surgery performed during 1999 in 2394 eyes of 2213 persons at two new rural eye centres set up in these areas that pay particular attention to the quality of eye care. Blindness in an eye was defined as presenting distance visual acuity less than 6/60, and in a person as this acuity level in the better eye. These data were extrapolated to India. In the population-based sample, of the 129 operated eyes, 51 (39.5%) were blind after surgery, which included 41 (31.8%) from cataract surgery-related causes. Of the 106 persons in the population sample who had had cataract surgery in one or both eyes, 26 (24.5%) were still blind. In contrast, for the cataract surgery at the two rural eye centres paying attention to quality, 3.1% of the eyes and 1.8% of the persons were blind soon after surgery, but these figures could increase 2.6 times over the lifetime of these persons. The 3.5 million cataract surgeries in India in 2000 are estimated to result in 0.32 million persons having blindness averted over their lifetime. To eliminate cataract blindness in India, an estimated 9 million good-quality cataract surgeries are needed every year during 2001-2005, increasing to over 14 million surgeries needed every year during 2016-2020 on persons most likely to go blind from cataract. The number of persons in whom blindness is being averted due to cataract surgery in India is currently a very small fraction of the number blind from cataract. If adequate attention is given to the quality of eye care, for the current number of cataract surgeries in India it should be possible to increase by threefold the number in whom blindness can be averted with cataract surgery. In addition to improving quality, the annual number of cataract surgeries has to be at least threefold the current number during 2006-2010 if cataract blindness in India is to be eliminated.

Cataract surgery in children with chronic uveitis

Objective To evaluate the visual outcome of cataract surgery in children’s eyes with chronic uveitis and the feasibility of intraocular lens (IOL) implantation in these cases. Design Retrospective noncomparative case series. Participants Seventeen children (20 eyes) with chronic uveitis, dense cataract, and a preoperative visual acuity of 6/120 or less with follow-up of 5 years after the initial cataract surgery. Methods In 10 eyes of 10 children (five with juvenile rheumatoid arthritis [JRA] and five with non-JRA-associated uveitis) with uniocular or markedly unequal binocular disease, surgery was carried out through the limbus and a posterior chamber IOL was implanted. In seven children (10 eyes), three with JRA and four with non-JRA-associated disease, a pars plana approach was used, and contact lenses or glasses (for the bilateral cases) were prescribed. Results The postoperative course and immediate restored visual acuities were similar whether an IOL was implanted or not. One month after the surgery, visual acuity improved in all operated eyes. After monocular surgery, in the younger children, contact lenses were poorly tolerated and their use discontinued. These aphakic eyes remained with low vision, developing strabismus on longer follow-up. Children with JRA-associated uveitis were younger, demonstrated an active intraocular inflammation for an extended period after surgery, and tended to have secondary membranes develop, necessitating a second surgical intervention. Five years after the initial surgery, only two of nine eyes (22%) in the JRA group (one aphakic of a bilaterally affected child and one pseudophakic in a child undergoing cataract surgery in one eye) retained a visual acuity of 6/9 and 6/6, respectively. In the other seven eyes, the visual acuity was 6/60 in one pseudophakic eye and 6/240 or less in six eyes (three aphakic and three pseudophakic). In children with non-JRA-associated uveitis, 6 (four aphakic in two patients bilaterally affected and two pseudophakic) of 11 eyes (54.5%) retained a vision of 6/12 or better. Conclusions Cataract surgery in children’s eyes with uveitis may be beneficial. IOL implantation seems preferable to correction with contact lenses in young children needing surgery in one eye. In children with JRA-associated uveitis, the final visual results remain guarded because of irreversible amblyopia and a more complicated postoperative course. For these cases, a modified management approach and a better surgical technique are needed.

Population-based assessment of the outcome of cataract surgery in an urban population in southern India

PURPOSE: To assess the outcome of cataract surgery in an urban population in southern India. METHODS: As part of a population-based cross-sectional epidemiologic study, the Andhra Pradesh Eye Disease Study, 2,522 people of all ages, including 1,399 individuals 30 years of age or older, from 24 clusters representative of the population of Hyderabad in southern India underwent a detailed interview and ocular evaluation including logarithm of minimal angle of resolution (logMAR) visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, dilation, cataract grading, aphakia/pseudophakia status, and stereoscopic fundus evaluation. Automated threshold visual fields and slit-lamp and fundus photography were performed when indicated by standardized criteria. Very poor outcome in an eye that had undergone cataract surgery was defined as presenting distance visual acuity worse than 20/200, and poor outcome was defined as visual acuity worse than 20/60 to 20/200. RESULTS: In subjects 50 years of age or older, after adjustment for age and sex distribution, the rate of having had cataract surgery in one or both eyes was 14.6% (95% confidence interval [CI], 11.4% to 17.8%). Of 131 eyes (91 subjects) that had undergone cataract surgery, 28 (21.4%; 95% CI, 14.4% to 28.4%) had very poor outcome and another 40 (30.5%; 95% CI, 22.6% to 38.4%) had poor outcome. The very poor outcome in 20 (71.4%) of 28 eyes and poor outcome in 23 (57.5%) of 40 eyes could be attributed to surgery-related causes or inadequate refractive correction. With multivariate analysis, very poor outcome as a result of surgery-related causes or inadequate refractive correction was more likely to be associated with intracapsular cataract extraction than with extracapsular cataract extraction (odds ratio, 9.34; 95% CI, 2.49 to 35.06) in subjects belonging to the lowest socioeconomic status (odds ratio, 4.92; 95% CI, 1.16 to 20.93) and with date of surgery 3 or fewer years before the survey than with more than 3 years (odds ratio, 4.52; 95% CI, 1.33 to 15.39). Also, very poor or poor outcome as a result of surgery-related causes or inadequate refractive correction was associated with women (odds ratio, 2.55; 95% CI, 1.06 to 6.16). CONCLUSIONS: The very high rate of very poor and poor visual outcome, predominantly as a result of surgery-related causes and inadequate refractive correction, in this urban population of India suggests that more attention is needed to improve the visual outcome of cataract surgery. In order to deal with cataract-related visual impairment in India, as much emphasis on surgical quality, refractive correction, and follow-up care is necessary as on the number of surgeries.

Evaluation of visual outcome of cataract surgery in an Indian eye camp

AIMTo evaluate the results of cataract surgery performed in a rural Indian eye camp.METHODThe pre- and postoperative visual acuities and surgical complications were recorded prospectively in 6383 eyes undergoing cataract...

Visual outcome and progression of retinopathy after cataract surgery in diabetic patients.

Diabetes mellitus is a major cause of visual impairment in developed countries through retinopathy and is frequently complicated by cataract formation. The present study examines the visual outcome of cataract surgery in diabetic pat ents. A retrospective study was performed over a 26 month period in a general hospital eye clinic. Eighty-five consecutive diabetic patients who underwent cataract surgery were categorized according to their type of diabetes, duration and treatment, operative technique, pre-operative visual acuity (VA) and degree of retinopathy. Visual acuity and retinopathy status were recorded at a minimum of 4 months postoperatively. Factors affecting visual outcome and progression of retinopathy were then examined. Of the 107 eyes of the 85 consecutive cases, 55 were without retinopathy (NR), 21 had background retinopathy (BDR), six had background retinopathy with macular oedema (BDR/MO), four had proliferative retinopathy and 12 cases had inadequate fundal view. In the NR and BDR groups, 90 and 81% of patients, respectively, had improved VA compared with 33% of patients with BDR/MO. Retinopathy progressed in 50% of BDR/MO patients compared with progression in 9 and 19% of NR and BDR patients, respectively. The present study illustrates the poor visual outcome in patients with severe, untreated retinopathy, particularly maculopathy, following cataract surgery. Larger prospective studies are needed to better define risk groups and pre-operative treatment strategies.

Cataract Surgery in Patients with Sarcoidosis-associated Uveitis

The authors analyzed the incidence of cataract development and the visual outcome of cataract surgery performed on patients with sarcoidosis-associated uveitis who were treated at the Immunology Service at the Massachusetts Eye and Ear Infirmary during a 17-year period. The records of 102 patients with sarcoidosis-associated uveitis who were treated with topical and regional corticosteroids, systemic nonsteroidal anti-inflammatory drugs, systemic steroids, or with systemic immunosuppressive chemotherapy were reviewed. Cataract surgery was performed on those eyes in which cataract developed, resulting in decreased visual acuity of 20/100 or less. The incidence of cataract development and visual results of cataract extraction and intraocular lens implantation were analyzed. In this cohort of 102 patients, visually significant cataracts that warranted surgery developed in 10 (16 eyes). In addition, four patients (5 eyes) had a visually significant cataract at the time of first evaluation. A total of 14 patients (21 eyes) underwent cataract surgery. Posterior chamber lens implantation accompanied cataract surgery in 19 (90.5%) of 21 eyes. The average final visual acuity of the 21 eyes after cataract surgery was 20/51, and 61% of the eyes achieved a stable visual acuity of 20/40 or better. The major causes of the decreased visual acuity in patients who had less than 20/40 visual acuity were sequelae of chronic posterior uveitis, cystoid macular edema, epiretinal membrane, and glaucomatous optic nerve damage. Posterior chamber lens implantation and cataract surgery in patients with sarcoidosis-associated uveitis can be well tolerated when absolute control of the inflammation is achieved. Pre-existing retinal pathology and glaucoma as a result of uncontrolled inflammation resulting in permanent ocular structural damage were found to be the most important factors for determining the postoperative final visual acuity.

Cataract Development and Cataract Surgery in Patients with Juvenile Rheumatoid Arthritis-associated Iridocyclitis

The authors used an aggressive stepladder, steroid-sparing, therapeutic algorithm in the care of patients with iridocyclitis associated with juvenile rheumatoid arthritis (JRA) to preserve vision, limit cataract formation, and improve probability of successful visual rehabilitation when cataract surgery became necessary. The authors treated 60 patients with JRA-associated iridocyclitis with topical and regional corticosteroids, systemic nonsteroidal anti-inflammatory drugs, systemic steroids, and systemic immunosuppressive chemotherapy to achieve total quiescence of intraocular inflammation. Cataract surgery (phacoemulsification extracapsular cataract extraction) combined with pars plana vitrectomy was performed on those eyes with cataract sufficient to limit visual acuity to 20/200 or less, after maintenance of complete freedom from inflammation for at least 3 months. The incidence of cataract development and the visual outcome of cataract surgery were analyzed in those patients for whom a minimum follow-up of 1 year was available. Eventually, 10 of the 60 patients required systemic immunosuppressive chemotherapy in the stepladder therapeutic approach to achieve complete abolition of all active inflammation. Of 72 phakic eyes without cataract, significant cataract developed in 13 (18%) while under our care. The average postoperative stable visual acuity in this group was 20/40. Sixteen eyes of 12 additional patients had visually significant cataract at the time of our first evaluation of them. The average postoperative stable visual acuity in this group of patients after cataract surgery was 20/40. Iridocyclitis associated with JRA is an insidiously blinding disease, with 12% of individuals affected by this problem eventually blinded by the inflammatory consequences to the eye. A therapeutic philosophy of complete intolerance for active inflammation and limited tolerance for chronic steroid use may offer the most realistic hope for the next step in progress to prevent blindness in this patient population. The results of this study suggest that such a therapeutic attitude results in diminished cataract prevalence and decreased prevalence of vision-limiting retinal pathology, with resultant improved visual outcome of the cataract surgery which is eventually needed in a small proportion of the patients.