Cataract Surgery with IOL Implantation in Children with Chronic Anterior Uveitis Associated with Juvenile Idiopathic Arthritis (JIA) or Antinuclear Antibody (ANA)-Positive Uveitis: Mid-term Results and Predictors for Outcome

Abstract

Purpose

To investigate the clinical course and 2-year outcome after cataract surgery with implantation of intraocular lenses (IOL) in children with juvenile idiopathic arthritis (JIA)-associated uveitis or chronic antinuclear antibody (ANA)-positive uveitis.

Design

Retrospective interventional clinical study.

Subjects

Children with cataract surgery at ≤10 years of age.

Methods

Comprehensive uveitis-related data (defined by Standardization of Uveitis Nomenclature standards) were collected before, during and 6 weeks, 1 and 2 years after surgery. Surgical procedures involved small incision phacoemulsification, insertion of foldable acrylic IOLs with a sharp-edge design into the capsular bag, 25 G anterior vitrectomy, posterior capsulectomy, and intravitreal triamcinolone injection. Surgical technique was modified individually according to pre-existing uveitis-related morphological abnormalities.

Main Outcome Measures

Best-corrected visual acuity (BCVA) and postoperative complications.

Results

All 100 surgeries (81 patients, 100% ANA-positive, 69% female, 90.1% JIA, mean age at JIA diagnosis 4.26 ± 2.35 years) involved insidious-onset anterior uveitis (mean age at uveitis onset 4.6 ± 2.1 years). Surgery was performed at a mean age of 8.2 ± 3.3 years (SD 3.2), and under treatment with conventional synthetic disease-modifying anti-rheumatic drugs (DMARD; 90%), or 45% biologicals. Prior to surgery, uveitis-related complications were present alongside cataract in 99% of patients (eg. lens fibrotic membrane and pupil contraction). BCVA (logMAR) was 1.57 ± 1.24 before surgery, and was 0.32 ± 0.51 and 0.3 ± 0.53 at 1 and 2 years after surgery, respectively (each, P < .001). Fibrin formation was present in 39.6% of cases on the first day after surgery. After 1 and 2 years of surgery, macular edema was present in 4.6% and 9.4%, and glaucomatous optic discs in 17.3% and 18.9%, respectively. Preoperative predictors of poor 2-year visual outcome included poor BCVA, high laser flare (LF) values, unilateral uveitis, and glaucoma medication. Preoperative predictors of 2-year postoperative ocular complications included band keratopathy and a lack of methotrexate or adalimumab use.

Conclusions

According to our observations, IOL implantation can be considered for children with JIA-associated or ANA-positive uveitis, on the condition that their uveitis is well controlled with DMARD therapy and the surgical technique is appropriate. The long-term course of the inflammatory disease determines the occurrence of intraocular complications related to inflammation and the visual outcome.