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ME Meniconi, EN Yu, F Tufail, WG Christen, CS Foster; Outcomes of Treatment with Immunomodulatory Therapy in Juvenile Idiopathic Arthritis-Associated Chronic Iridocyclitis . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4274.
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Purpose: To evaluate the outcomes of patients with juvenile idiopathic arthritis (JIA)-associated chronic iridocyclitis, and to compare the outcomes of «early» and «late» immunomodulatory therapy. Methods: Medical records of patients with JIA-associated chronic iridocyclitis seen on the Ocular Immunology & Uveitis Service of the Massachusetts Eye and Ear Infirmary between 1981 and 1997 were reviewed. Results: Twenty-three patients (45 eyes) were included in the study. Patient eyes were assigned to Groups A (early treatment), B (late treatment) or C (very late treatment) depending on the timing of initiation of effective chemotherapy in the disease course. All except one eye in Group A (94%) had 20/20 to 20/40 visual acuity at final visit. Twenty percent and 36% of eyes from Groups B and C, respectively, had 20/20 to 20/40 vision. About half of the eyes from these two latter groups had 20/200 or worse vision at the time of data analysis. Less than half (44%) of eyes in Group A developed cataract requiring cataract extraction, while 100% and 86% of the patients in Groups B and C, respectively, required surgery. None of the eyes of patients in Group A progressed to hypotony and phthisis over the course of follow-up, whereas eight of the 29 eyes in Groups B and C did. Conclusion: JIA-associated chronic iridocyclitis is a potentially blinding disease. Better outcomes occur when steroid-sparing immunomodulatory therapy is given early in the disease course in patients who continue to have inflammation despite treatment with steroids.
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