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Sarah Devaro, Laura Ward, Phoebe Lenhart, Jessica Shantha, Ghazala O'Keefe; Outcomes of cataract surgery in pediatric uveitis patients on systemic immunomodulatory therapy. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1413.
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© ARVO (1962-2015); The Authors (2016-present)
Compare outcomes of cataract surgery in pediatric uveitis between 3 treatment groups: no systemic treatment, antimetabolites, and biologic response modifiers (BRM) +/- antimetabolites.
Retrospective chart review of uveitis patients younger than 18 years who underwent cataract surgery at Emory Eye Center in Atlanta, GA 2008-2020. Data collected included demographics, treatment, visual acuity (VA) and postoperative complications, all summarized as frequencies. SPSS software was used for descriptive and inferential statistical analysis. Univariate analyses were performed to compare treatment groups. VA was tested by time and treatment group adjusting for correlation between covariates and eyes over time.
51 patients were included; 31 (61%) were female. Mean age at surgery was 10.8 years (range 4-17). Anterior uveitis (62%) was most common anatomic location. Of 65 eyes, 20 (31%) were on antimetabolites, most commonly methotrexate (95%); 19 (29%) were on BRM +/- antimetabolites, most commonly infliximab (68%); and 26 (40%) were on no systemic immunomodulation. Of eyes on no treatment, 54% were on oral corticosteroids perioperatively. 14 (74%) patients on BRM also received antimetabolites (mean duration 19.9 months). Mean age at diagnosis was significantly lower in those on BRM (p=0.009). Patients with juvenile idiopathic arthritis (JIA) were more frequently on BRM (p=0.018). All groups had similar rates of amblyopia, average length of quiescence and number of flares in year prior to surgery. Postoperative complications (prolonged inflammation or development of cystoid macular edema or posterior capsular opacification) approached significance. Intraocular pressure (IOP) increased in all eyes over time (p=0.0069) but was significantly higher in BRM compared with anti-metabolites (p=0.0002) or all-comers (p=0.0128). VA in all eyes improved after surgery, with significantly better VA in BRM compared to the rest of the cohort (p = 0.002).
Cataract surgery improved visual outcomes in pediatric uveitis regardless of treatment. Despite younger age of diagnosis, patients on BRM had significantly better long-term vision but also increased IOP. Postoperative complications were similar across groups. This is the first report of outcomes after cataract surgery in pediatric uveitis comparing available treatments.
This is a 2021 ARVO Annual Meeting abstract.
Demographics of 51 pediatric uveitis patients undergoing cataract surgery
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