In children with juvenile rheumatoid arthritis (JRA), uveitis is not a contraindication for intraocular lens implantation, researchers from Israel and Australia believe. In a current survey, the scientists found no significant difference in postoperative course or complications compared to children with non-JRA-associated uveitis. However the authors recommend aggressive medical treatment for controlling inflammation.
Arie Nemet from the Meir Medical Center in Kfar-Saba (Israel) and colleagues evaluated postoperative inflammation, complications and visual outcome of cataract surgery with posterior chamber intraocular lens implantation in 18 children with uveitis (a total of 19 eyes). “Cataract surgery in children with intraocular inflammation remains an open controversy in the ophthalmic literature”, Nemet notes.
The ten participants with JRA-associated uveitis tended to have a more severe disease at presentation and a more pronounced inflammatory reaction after surgery. Despite this, intraocular lens implantation was well tolerated also in the JRA group. Visual acuity improved by two or more lines in all children and in 13 eyes the final visual acuity was 20/40 or better. Postoperative complications included elevated intraocular pressure, posterior and anterior capsular opacities and macular dysfunction, the authors write.
Nevertheless, in children with JRA "a foldable intraocular lens inserted through a small corneal incision appears to be well tolerated, in combination with aggressive medical treatment to control the preoperative inflammation," Nemet resumes. JG
Arch Ophthalmol (2007); 125: 354-60
http://archopht.ama-assn.org
