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Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis
. Purpose: Management of uveitic cataract in patients with juvenile idiopathic arthritis (JIA) is challenging, and intraocular lens (IOL) implantation is controversial. This study investigated the outcome after minimally invasive surgery with IOL implantation. Methods: Retrospective analysis after...
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Published in: | Acta ophthalmologica (Oxford, England) England), 2012-11, Vol.90 (7), p.657-662 |
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creator | Grajewski, Rafael S. Zurek-Imhoff, Beatrix Roesel, Martin Heinz, Carsten Heiligenhaus, Arnd |
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Purpose: Management of uveitic cataract in patients with juvenile idiopathic arthritis (JIA) is challenging, and intraocular lens (IOL) implantation is controversial. This study investigated the outcome after minimally invasive surgery with IOL implantation.
Methods: Retrospective analysis after phacoemulsification with in‐the‐bag IOL implantation was performed in 16 patients (17 operations) with ANA‐positive JIA‐associated chronic uveitis. In these patients, 25 G capsulectomy and anterior vitrectomy was performed and they received an intravitreal triamcinolone (TA) injection.
Results: Mean age at uveitis onset was 5 ± 2 years, and surgery was performed at a mean age of 11 ± 2.2 years. Preoperatively, uveitis was inactive in all patients, and visual acuity was logMAR 0.8 ± 0.44; additional uveitis complications were present in all patients, and 15 patients were receiving systemic immunosuppression/biologicals.
After surgery (mean follow‐up 26.5 ± 11.7 months), presence of cystoid macular oedema, papilloedema, ocular hypertension/glaucoma and hypotony did not increase compared with baseline. There was no significant worsening of AC inflammation (by cell numbers and laser flare values). IOL deposits persisted in four patients, and synechiae developed in eight. The visual acuity was improved (≥2 lines) in all patients (mean logMAR 0.3 ± 0.24). Retrolental membrane formation was not noted. Secondary capsular opacification was observed in seven patients, requiring Nd:YAG capsulotomy in five of them.
Conclusions: Phacoemulsification and in‐the‐bag IOL implantation may improve visual outcome in JIA‐associated uveitis with minimally invasive surgical technique and intravitreal TA injection. Well‐controlled uveitis with appropriate use of topical steroids and systemic immunosuppression or biologicals appears as a perioperative requirement. |
doi_str_mv | 10.1111/j.1755-3768.2011.02110.x |
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Purpose: Management of uveitic cataract in patients with juvenile idiopathic arthritis (JIA) is challenging, and intraocular lens (IOL) implantation is controversial. This study investigated the outcome after minimally invasive surgery with IOL implantation.
Methods: Retrospective analysis after phacoemulsification with in‐the‐bag IOL implantation was performed in 16 patients (17 operations) with ANA‐positive JIA‐associated chronic uveitis. In these patients, 25 G capsulectomy and anterior vitrectomy was performed and they received an intravitreal triamcinolone (TA) injection.
Results: Mean age at uveitis onset was 5 ± 2 years, and surgery was performed at a mean age of 11 ± 2.2 years. Preoperatively, uveitis was inactive in all patients, and visual acuity was logMAR 0.8 ± 0.44; additional uveitis complications were present in all patients, and 15 patients were receiving systemic immunosuppression/biologicals.
After surgery (mean follow‐up 26.5 ± 11.7 months), presence of cystoid macular oedema, papilloedema, ocular hypertension/glaucoma and hypotony did not increase compared with baseline. There was no significant worsening of AC inflammation (by cell numbers and laser flare values). IOL deposits persisted in four patients, and synechiae developed in eight. The visual acuity was improved (≥2 lines) in all patients (mean logMAR 0.3 ± 0.24). Retrolental membrane formation was not noted. Secondary capsular opacification was observed in seven patients, requiring Nd:YAG capsulotomy in five of them.
Conclusions: Phacoemulsification and in‐the‐bag IOL implantation may improve visual outcome in JIA‐associated uveitis with minimally invasive surgical technique and intravitreal TA injection. Well‐controlled uveitis with appropriate use of topical steroids and systemic immunosuppression or biologicals appears as a perioperative requirement.</description><identifier>ISSN: 1755-375X</identifier><identifier>EISSN: 1755-3768</identifier><identifier>DOI: 10.1111/j.1755-3768.2011.02110.x</identifier><identifier>PMID: 21310018</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Arthritis, Juvenile - complications ; Arthritis, Juvenile - drug therapy ; Arthritis, Juvenile - physiopathology ; Cataract - etiology ; cataract surgery ; Cataracts ; Child ; Female ; Humans ; Immunosuppressive Agents - therapeutic use ; intraocular lens implantation ; Intraocular Pressure ; juvenile idiopathic arthritis ; Lens Implantation, Intraocular ; Male ; microincisional vitrectomy ; Ophthalmology ; Phacoemulsification ; Retrospective Studies ; Surgery ; Treatment Outcome ; triamcinolone acetonide ; uveitis ; Uveitis - complications ; Uveitis - drug therapy ; Uveitis - physiopathology ; Visual Acuity - physiology ; Vitrectomy</subject><ispartof>Acta ophthalmologica (Oxford, England), 2012-11, Vol.90 (7), p.657-662</ispartof><rights>2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation</rights><rights>2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4350-ed6f2146f005427390cdb290da1c9e0c4d5c5a78065367d776702c30d8e3cd4f3</citedby><cites>FETCH-LOGICAL-c4350-ed6f2146f005427390cdb290da1c9e0c4d5c5a78065367d776702c30d8e3cd4f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21310018$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Grajewski, Rafael S.</creatorcontrib><creatorcontrib>Zurek-Imhoff, Beatrix</creatorcontrib><creatorcontrib>Roesel, Martin</creatorcontrib><creatorcontrib>Heinz, Carsten</creatorcontrib><creatorcontrib>Heiligenhaus, Arnd</creatorcontrib><title>Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis</title><title>Acta ophthalmologica (Oxford, England)</title><addtitle>Acta Ophthalmol</addtitle><description>.
Purpose: Management of uveitic cataract in patients with juvenile idiopathic arthritis (JIA) is challenging, and intraocular lens (IOL) implantation is controversial. This study investigated the outcome after minimally invasive surgery with IOL implantation.
Methods: Retrospective analysis after phacoemulsification with in‐the‐bag IOL implantation was performed in 16 patients (17 operations) with ANA‐positive JIA‐associated chronic uveitis. In these patients, 25 G capsulectomy and anterior vitrectomy was performed and they received an intravitreal triamcinolone (TA) injection.
Results: Mean age at uveitis onset was 5 ± 2 years, and surgery was performed at a mean age of 11 ± 2.2 years. Preoperatively, uveitis was inactive in all patients, and visual acuity was logMAR 0.8 ± 0.44; additional uveitis complications were present in all patients, and 15 patients were receiving systemic immunosuppression/biologicals.
After surgery (mean follow‐up 26.5 ± 11.7 months), presence of cystoid macular oedema, papilloedema, ocular hypertension/glaucoma and hypotony did not increase compared with baseline. There was no significant worsening of AC inflammation (by cell numbers and laser flare values). IOL deposits persisted in four patients, and synechiae developed in eight. The visual acuity was improved (≥2 lines) in all patients (mean logMAR 0.3 ± 0.24). Retrolental membrane formation was not noted. Secondary capsular opacification was observed in seven patients, requiring Nd:YAG capsulotomy in five of them.
Conclusions: Phacoemulsification and in‐the‐bag IOL implantation may improve visual outcome in JIA‐associated uveitis with minimally invasive surgical technique and intravitreal TA injection. Well‐controlled uveitis with appropriate use of topical steroids and systemic immunosuppression or biologicals appears as a perioperative requirement.</description><subject>Arthritis, Juvenile - complications</subject><subject>Arthritis, Juvenile - drug therapy</subject><subject>Arthritis, Juvenile - physiopathology</subject><subject>Cataract - etiology</subject><subject>cataract surgery</subject><subject>Cataracts</subject><subject>Child</subject><subject>Female</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>intraocular lens implantation</subject><subject>Intraocular Pressure</subject><subject>juvenile idiopathic arthritis</subject><subject>Lens Implantation, Intraocular</subject><subject>Male</subject><subject>microincisional vitrectomy</subject><subject>Ophthalmology</subject><subject>Phacoemulsification</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>triamcinolone acetonide</subject><subject>uveitis</subject><subject>Uveitis - complications</subject><subject>Uveitis - drug therapy</subject><subject>Uveitis - physiopathology</subject><subject>Visual Acuity - physiology</subject><subject>Vitrectomy</subject><issn>1755-375X</issn><issn>1755-3768</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNqNkkFv1DAQhSMEoqXwF5AlLlyyzMSxnRw4tBUtlRb2AJTeLK_tsA6bZLGddvff45CyB0744pHe98b2PGcZQVhgWu_aBQrGcip4tSgAcQEFJm3_JDs9Ck-PNbs7yV6E0AJw5Lx8np0USBEAq9Nsf6Xuh9Gr9daSYYx66CxRTbSeaBWVVzqSMPof1h_Ig4sbcrNaEtfttqqPKrqhJ64n47110QWiQhi0U9GamW2T0LvU2Bk37FTcOE2Ujxs_0S-zZ43aBvvqcT_Lvl19-Hr5MV-urm8uz5e5LimD3BreFFjyBoCVhaA1aLMuajAKdW1Bl4ZppkQFnFEujBBcQKEpmMpSbcqGnmVv5747P_wabYiyc0HbbXqBHcYgEYtSsAo5JvTNP2ibRtOn2yUKGaNlDXWiqpnSfgjB20buvOuUP0iEiUPZymnwcgpBTunIP-nIfbK-fjxgXHfWHI1_40jA-xl4SGM7_Hdjeb76MlXJn89-F6LdH_3K_5RcpI8gv3--lp8u2MUtvb2TQH8DJvquAw</recordid><startdate>201211</startdate><enddate>201211</enddate><creator>Grajewski, Rafael S.</creator><creator>Zurek-Imhoff, Beatrix</creator><creator>Roesel, Martin</creator><creator>Heinz, Carsten</creator><creator>Heiligenhaus, Arnd</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7X8</scope></search><sort><creationdate>201211</creationdate><title>Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis</title><author>Grajewski, Rafael S. ; Zurek-Imhoff, Beatrix ; Roesel, Martin ; Heinz, Carsten ; Heiligenhaus, Arnd</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4350-ed6f2146f005427390cdb290da1c9e0c4d5c5a78065367d776702c30d8e3cd4f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Arthritis, Juvenile - complications</topic><topic>Arthritis, Juvenile - drug therapy</topic><topic>Arthritis, Juvenile - physiopathology</topic><topic>Cataract - etiology</topic><topic>cataract surgery</topic><topic>Cataracts</topic><topic>Child</topic><topic>Female</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>intraocular lens implantation</topic><topic>Intraocular Pressure</topic><topic>juvenile idiopathic arthritis</topic><topic>Lens Implantation, Intraocular</topic><topic>Male</topic><topic>microincisional vitrectomy</topic><topic>Ophthalmology</topic><topic>Phacoemulsification</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>triamcinolone acetonide</topic><topic>uveitis</topic><topic>Uveitis - complications</topic><topic>Uveitis - drug therapy</topic><topic>Uveitis - physiopathology</topic><topic>Visual Acuity - physiology</topic><topic>Vitrectomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grajewski, Rafael S.</creatorcontrib><creatorcontrib>Zurek-Imhoff, Beatrix</creatorcontrib><creatorcontrib>Roesel, Martin</creatorcontrib><creatorcontrib>Heinz, Carsten</creatorcontrib><creatorcontrib>Heiligenhaus, Arnd</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Acta ophthalmologica (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grajewski, Rafael S.</au><au>Zurek-Imhoff, Beatrix</au><au>Roesel, Martin</au><au>Heinz, Carsten</au><au>Heiligenhaus, Arnd</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis</atitle><jtitle>Acta ophthalmologica (Oxford, England)</jtitle><addtitle>Acta Ophthalmol</addtitle><date>2012-11</date><risdate>2012</risdate><volume>90</volume><issue>7</issue><spage>657</spage><epage>662</epage><pages>657-662</pages><issn>1755-375X</issn><eissn>1755-3768</eissn><abstract>.
Purpose: Management of uveitic cataract in patients with juvenile idiopathic arthritis (JIA) is challenging, and intraocular lens (IOL) implantation is controversial. This study investigated the outcome after minimally invasive surgery with IOL implantation.
Methods: Retrospective analysis after phacoemulsification with in‐the‐bag IOL implantation was performed in 16 patients (17 operations) with ANA‐positive JIA‐associated chronic uveitis. In these patients, 25 G capsulectomy and anterior vitrectomy was performed and they received an intravitreal triamcinolone (TA) injection.
Results: Mean age at uveitis onset was 5 ± 2 years, and surgery was performed at a mean age of 11 ± 2.2 years. Preoperatively, uveitis was inactive in all patients, and visual acuity was logMAR 0.8 ± 0.44; additional uveitis complications were present in all patients, and 15 patients were receiving systemic immunosuppression/biologicals.
After surgery (mean follow‐up 26.5 ± 11.7 months), presence of cystoid macular oedema, papilloedema, ocular hypertension/glaucoma and hypotony did not increase compared with baseline. There was no significant worsening of AC inflammation (by cell numbers and laser flare values). IOL deposits persisted in four patients, and synechiae developed in eight. The visual acuity was improved (≥2 lines) in all patients (mean logMAR 0.3 ± 0.24). Retrolental membrane formation was not noted. Secondary capsular opacification was observed in seven patients, requiring Nd:YAG capsulotomy in five of them.
Conclusions: Phacoemulsification and in‐the‐bag IOL implantation may improve visual outcome in JIA‐associated uveitis with minimally invasive surgical technique and intravitreal TA injection. Well‐controlled uveitis with appropriate use of topical steroids and systemic immunosuppression or biologicals appears as a perioperative requirement.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>21310018</pmid><doi>10.1111/j.1755-3768.2011.02110.x</doi><tpages>6</tpages></addata></record> |
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subjects | Arthritis, Juvenile - complications Arthritis, Juvenile - drug therapy Arthritis, Juvenile - physiopathology Cataract - etiology cataract surgery Cataracts Child Female Humans Immunosuppressive Agents - therapeutic use intraocular lens implantation Intraocular Pressure juvenile idiopathic arthritis Lens Implantation, Intraocular Male microincisional vitrectomy Ophthalmology Phacoemulsification Retrospective Studies Surgery Treatment Outcome triamcinolone acetonide uveitis Uveitis - complications Uveitis - drug therapy Uveitis - physiopathology Visual Acuity - physiology Vitrectomy |
title | Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis |
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