Cataract Extraction and Fluocinolone Implant in Juvenile Idiopathic Arthritis

Abstract

Purpose: : We report three eyes with juvenile idiopathic arthritis (JIA) who underwent fluocinolone implant (Retisert^TM, Bausch & Lomb, Rochester, NY) and cataract extraction with posterior chamber intraocular lens implantation and had successful outcome.

Methods: : The first patient, a 14-year-old female, underwent combined fluocinolone implant and cataract extraction with posterior chamber intraocular lens implantation, first in the left eye and then in the right eye. The second patient, a 6-year-old female, had cataract extraction and intraocular lens implantation with successive formation of severe posterior synechiae and pupillary block glaucoma. Subsequently, she underwent synechiolysis and fluocinolone implant.

Results: : The follow-up was 24 months for the right eye and 18 months for the left eye of the first patient and 3 months for the second patient. Initial best corrected visual acuity (BCVA) was 20/70, 20/25, and 20/400 for those three eyes and improved to 20/25, 20/20, and 20/80 respectively. Posterior synechiae reformed in only one eye (left eye of the first patient) 12 months after the fluocinolone implant; consequently the implant was exchanged with a new one 18 months after the first implant. Intraocular pressure increased (>10 mmHg from baseline, or above 22 mmHg) only in the left eye of the first patient and was well-controlled with topical medications.

Conclusions: : Cataract extraction with posterior chamber intraocular lens implantation with fluocinolone implant can maintain steady suppression of inflammation, providing quality vision for patients with cataracts and chronic uveitis secondary to JIA.

Keywords: uveitis-clinical/animal model • corticosteroids • retina