Abstract
Abstract: :
Purpose: To evaluate results of cataract surgery in children with chronic uveitis who underwent surgery on the Ocular Immunology and Uveitis Service at Massachusetts Eye Ear Infirmary (MEEI). Study Desing: Retrospective case analysis. Material and Methods: Chart review of 25 children (31 eyes) from age 4 to 17 with uveitis who underwent cataract surgery with or without additional procedures between 1994 and 2002. Results:15 females 10 males. Etiology of uveitis: Juvenile Idiopathic Arthritis–associated uveitis (13), idiopathic pars planitis (5), idiopathic panuveitis (2), idiopathic granulomatous uveitis (1), herpetic keratouveitis (1), idiopathic anterior uveitis (1) and with sarcoid uveitis (1). Mean age of diagnosis of uveitis: 6.92 years of age (4–16), SD± 3.03, mean age of presentation to our service was 9.14 years, SD±4.08. Age at the time of surgery: 10.38 years, SD±4.37. Of 31 eyes undergoing surgery, 2 had active uveitis (2+ cells) preoperatively despite maximum therapy. 21 patients were on immunomodulatory therapy at the time of surgery. 1 eye had phacoemulsification (PHACO) without intraocular lens (IOL) implantation; 6 eyes had posterior lens implantation (PHACO + PCIOL), 14 eyes had pars plana vitrectomy (PHACO + PPV), 7 eyes had PHACO + IOL + PPV and 3 eyes had extracapsular cataract extraction + PPV. 3 patients had Ahmed valve implantation with PHACO and an additional procedure (IOL or PPV). We were unable to examine the fundus preoperatively in 11 patients (13eyes) due to dense cataract. Mean preoperative visual acuity (VA) was 20/155; 8 patients had VA <20/400. One week after the surgery mean VA was 20/113; 9 patients had VA <20/400. At 6 months after the surgery mean visual acuity was 20/85; 1 patient had VA <20/400. IOP was elevated in 2 patients, and 3 had active uveitis (2+cells). At one year mean visual acuity was 20/90; 2 patients had VA <20/400, IOP was under control in all patients, 3 had active uveitis and 18 were on immunomodulatory therapy Mean follow up was 46.54months, SD–47.66 Early postoperative complications included: hyphema (4) vitreous hemorrhage (2), iris bombey (1), giant cells on IOL implant (2) Late postoperative complications: were: glaucoma(2), posterior capsular opacity(3), and one localized retinal detachment. Conclusion: In properly selected cases with close follow up, cataract surgery significantly improved visual acuity with few complications.
Keywords: cataract • inflammation • uveitis–clinical/animal model