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Madeleine Zetterberg, Sara Pålsson, Marita Gronlund, Alf Nyström; Combined phacoemulsification, primary IOL implantation and pars plana vitrectomy in children with uveitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1843. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the outcome of combined cataract surgery with primary intraocular lens (IOL) implantation and pars plana vitrectomy (PPV) in children with uveitis.
A retrospective non-comparative case series evaluated the outcome of 21 eyes of 17 children with chronic uveitis who underwent combined cataract surgery with primary IOL implantation and PPV at the Eye Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden, between 2002 and 2011. Main outcome measures were visual acuity (VA), inflammatory status, medical therapy pre- and postoperatively and intra-/postoperative complications.
A majority of the children (76%) suffered from uveitis associated with antinuclear antibody (ANA)-positive juvenile idiopathic arthritis. Median age at surgery was 6.5 years (range 3.4 to 14.8 years) and median follow-up period was 3.3 years (range 0.9 to 7.7 years). Median preoperative VA was 1.70 logMAR (0.02 dec; range light perception to 0.52 logMAR [0.3 dec]) and median VA at 12 months postoperatively was 0.17 logMAR (0.67 dec; range 1.05 logMAR [0.09 dec] to 0.00 logMAR [1.0 dec]). At last follow-up, 16 eyes (76%) had a VA of 0.30 logMAR (0.5 dec) or better. Six of these (29%) had a VA of 0.00 logMAR (1.0 dec). Three eyes had a VA below 0.52 logMAR (0.3 dec). During the follow-up period glaucoma developed in seven eyes (33%), cystoid macular edema in three eyes (14%) and in five eyes (24%) posterior capsule opacification (PCO) requiring surgical discission or Nd:YAG laser capsulotomy occurred. In 15 eyes (71%), intraocular inflammation was reduced or unaltered at the last follow-up as compared to preoperatively. In the remaining six eyes (29%), a slight increase in intraocular inflammatory reaction was seen.
A combined procedure with phacoemulsification, primary IOL implantation, and PPV appears to be a safe surgical approach in children with uveitis and the complication rate is comparable with that reported for cataract surgery alone in pediatric patients with uveitis. In a majority of the patients visual outcome was good and inflammation remained stable after surgery.
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