Pars plana lensectomy and vitrectomy for complicated cataracts in juvenile rheumatoid arthritis

Anterior surgical approaches to cataracts in juvenile rheumatoid arthritis (JRA) patients are compromised by chronic anterior and posterior uveitis, miotic pupils, and posterior synechiae. The authors retrospectively reviewed the results of pars plana lensectomy and vitrectomy in ten eyes from seven JRA patients with cataracts associated with chronic iridocyclitis and vitritis. Visual acuities improved from 20/100 or worse preoperatively to 20/60 or better postoperatively. Transient postoperative hypotony lasting 1 week to 4 months occurred in four of the ten eyes. Patients with glaucoma continued to require antiglaucoma therapy after surgery. Pars plana lensectomy and vitrectomy provides a theoretically preferrable approach to complicated cataracts and vitritis in JRA patients because it allows removal of peripheral lens material in the presence of a miotic pupil, eliminates the potential for synechiae to the posterior capsule and/or anterior hyaloid, and clears the visual axis of inflammatory debris.