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LA Lam, CY Lowder, SD Smith, EI Traboulsi, G Baerveldt; Surgical Management of Children with Juvenile Rheumatoid Arthritis-associated Uveitis . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4280.
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Introduction: Patients with Juvenile Rheumatoid Arthritis (JRA) associated uveitis often develop cataracts and secondary glaucoma due to chronic inflammation and corticosteroid use. Intraocular lens (IOL) implantation is controversial in these patients. Purpose: To describe the surgical outcome of cataract surgery with IOL and/or trabeculectomy in pediatric patients with JRA-associated uveitis. Design: Interventional case series. Methods: Chart review of all patients younger than age 18 with the diagnosis of JRA-associated uveitis who underwent cataract surgery with IOL and/or glaucoma surgery between December 1995 and August 2001. Results: Ten eyes of eight patients (7 girls, 1 boy), age 7 - 17 years (median 9.5 years at time of surgery) were included. Seven of eight patients had a positive antinuclear antibody titer and were on systemic methotrexate therapy for a median of 1.25 years prior to surgery. In addition, patients were on naproxen (3), hydroxychloroquine (2), prometheus (2) and etanercept (1). Two patients had bilateral surgeries. Two patients (3 eyes) underwent phacoemulsification cataract extraction with IOL (CE/PCIOL), 4 eyes had combined trabeculectomy with CE/PCIOL and 3 had trabeculectomy alone. Of the 7 eyes that received an IOL implant, 4 achieved 20/20 vision, 2 have 20/25 and 1 eye, 20/40 (follow-up 6 - 69 months; median 24 months). Four patients underwent combined CE/PCIOL and trabeculectomy, and 3 patients underwent trabeculectomy alone. Of the patients who underwent trabeculectomy, the preoperative intraocular pressure ranged from 28 - 49 (average 36.6) and improved to 3-24 ( average 9.9). Conclusion: Children with JRA-associated uveitis can do well following CE/PCIOL and/or trabeculectomy when the intraocular inflammation is adequately controlled.
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