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Damien Guindolet, Pascal Dureau, Catherine Edelson, Amandine Barjol, Céline Terrada, Georges Caputo, Phuc Lehoang, Bahram Bodaghi; Cataract surgery with or without primary lens implantation in children with chronic uveitis.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2508.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the management of cataract in children with uveitis and compare the visual outcome with or without primary lens implantation.
Retrospective study performed between 2007 and 2012 on children with chronic uveitis who underwent a cataract surgery, with primary posterior chamber IOL implantation with a foldable hydrophobic acrylic IOL or left aphakic.
The study included 20 eyes of 16 patients (9 Juvenile Idiopathic Arthritis). The mean age at surgery was 8.63 years (5.68-13.97) in 14 implanted eyes and 6.08 years (4.11-11.28; p=0.03) in 6 eyes which remained aphakic. The mean postoperative follow-up was 36.44 months (8.72-69.57). All patients except one were treated with methotrexate. Four patients (5 eyes) in the implanted group and 2 patients (2 eyes) in the apahakic group were additionally treated with TNF-alpha blockers. In the implanted and the aphakic groups, the preoperative mean BCVA was 1.11 logMAR (0.40-2.30) and 1.78 logMAR (0.70-2.30), respectively and the postoperative mean BCVA was 0.48 logMAR (0-3; p=0.02) and 0.47 logMAR (0-2.6; p=0.047), respectively. The baseline oral corticosteroids dosage in the implanted group and in the aphakic group was 8.14mg/d (0-30) and 6.17mg/d (0-15), respectively. It was increased to 27.9mg/d (0-55) and 25.83mg/d (15-40), respectively during the perioeprative period and tapered to 7.54mg/d (0-50) and 2.08mg/d (0-2.50), respectively at the end of the follow-up. Postoperative complications in the implanted group were posterior synachiae (5), posterior capsule opacification (1), cellular proliferation (8), cells on IOL (2), Elschnig pearls (5), secondary ocular hypertension (4), macular edema (5), retinal detachment (1). In the aphakic group complications were choroidal detachment (1) and intravitreal hemorrhage (2).
Pediatric cataract surgery in chronic uveitis with primary posterior chamber hydrophobic IOL implantation is possible and leads to a good and prompt visual rehabilitation. It requests a powerful anti-inflammatory management with immunosuppressive drugs. Nevertheless, JIA children below 6 years of age or those with severe uveitis or a previous failure of implantation in the opposite eye should remain aphakic.
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