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Long-term outcome of cataract management in juvenile idiopathic arthritis: simultaneous versus secondary intraocular lens implantation
Session Title: Complex Cases and Surgery
Session Date/Time: Monday 07/10/2013 | 14:30-16:00
Paper Time: 15:00
Venue: Forum (Ground Floor)
First Author: : R.Carelli ITALY
Co Author(s): : R. Forte L. Rombetto M. Alessio L. Latanza A. Magli
To compare primary versus secondary intraocular lens (IOL) implantation after cataract removal in patients with juvenile idiopathic arthritis (JIA).
The study was conducted at the Ophthalmology Department of an University Hospital in Italy (University of Salerno).The study design is retrospective.
Data were obtained from the medical records of 25 children (25 eyes) with JIA-associated uveitis operated on for cataract before the age of 16 years between January 1998 and January 2012. Main outcome measures were postsurgical complications and visual acuity after primary or secondary IOL implantation after cataract removal. Intraocular inflammation was controlled with corticosteroids and TNF-? blockers for a minimum of 3 months before undergoing surgery.
Thirteen patients underwent primary IOL implantation at a mean age of 12.2±2.2 (9-16) years. Mean follow up was 27.2±6.1 (12-42) months. Mean BCVA was 0.75 logMAR preoperatively and significantly improved during follow up (0.29 logMAR 1 month postoperatively, 0.27 logMAR at 12-month visit, and 0.35 logMAR at 24-month visit, p<0.05). Secondary glaucoma was observed in 9/13 patients (69.2%) and underwent trabeculectomy with mithomicin C in 7 cases. Twelve patients underwent cataract removal at a mean age 12.5±2.0 (9-16) years and secondary IOL implantation12.1±0.1 (11-14) months later. Mean follow up from cataract removal was 36.2±7.8 (12-50) months. Mean BCVA was 0.70 logMAR preoperatively and significantly improved during follow up ( 0.32 logMAR 1 month postoperatively, 0.21 logMAR at 12-month visit, and 0.22 logMAR at 24-month visit, p<0.05). BCVA difference between the two groups was significant at 24-month visit only (p=0.001). Secondary glaucoma was observed in 2/12 patients (16.6%). Incidence of secondary glaucoma was significantly lower in the group that underwent secondary IOL implantation (p=0.001).
Secondary IOL implantation after cataract removal in children with JIA-related uveitis provided a significantly lower incidence of secondary glaucoma.