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R. S. Grajewski, B. Zurek-Imhoff, M. Roesel, C. Heinz, A. Heiligenhaus; Favourable Outcome After Cataract Surgery With IOL Implantation in Patients With Juvenile Idiopathic Arthritis Associated Uveitis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5415.
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To investigate the outcome after minimal invasive surgery with IOL implantation and intraoperative intraocular triamcinolone injection in patients with uveitic cataract in juvenile idiopathic arthritis (JIA). The management of cataract in these patients is challenging, and IOL implantation is controversial.
Retrospective analysis after phacoemulsification with in the bag IOL implantation in 16 patients (17 surgeries) with ANA-positive JIA associated chronic uveitis. We performed a 25 G capsulectomy with anterior vitrectomy and intravitreal triamcinolone (TA) injection. Mean age at uveitis onset of 5±2 years, and surgery was performed at a mean age of 11±2.2 years. Preoperatively, uveitis was inactive in all patients, and visual acuity was logMAR 0.8±0.44; additional uveitis complications were present in all patients, and 14 patients were on systemic immunosuppression / biologicals.
After surgery (mean follow-up 15±9 months), presence of cystoid macular edema, papilledema, band keratopathy, ocular hypertension/glaucoma, and hypotony did not increase compared to baseline and to a control group without IOL implantation. By 1 year, IOL deposits were present in 4 patients, and synechiae in 9. There was no significant worsening of AC inflammation (by cell numbers and laser flare values) and no alteration of immunosuppressive therapy. The visual acuity was improved (≤ 2 lines) in all patients (mean logMAR 0.35). Retrolental membrane formation occurred in 6 patients, requiring Nd:YAG capsulotomy in 4 of them.
Phacoemulsification and in the bag IOL implantation may improve visual outcome in JIA associated uveitis with appropriate minimal invasive surgical technique including io TA injection. A perioperative requirement is well controlled uveitis with appropriate use of topical steroids and systemic immunosuppression or biologicals.
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