Intraocular lens implantation in patients with juvenile rheumatoid arthritis

To study intraocular lens implantation in patients with cataracts associated with juvenile rheumatoid arthritis.

We reviewed the records of seven patients (eight eyes) with juvenile rheumatoid arthritis who had undergone cataract extraction by phacoemulsification with intraocular lens implantation. Initial and final visual acuities, preoperative and postoperative medications, and early and late complications were recorded.

Posterior subcapsular cataracts and non-visually disabling peripheral band keratopathy were found in all eyes. The median postoperative follow-up was 17.5 months (mean, 16.6 months; range, nine to 36 months). Five patients were adults, and two patients were less than 10 years old. A best-corrected visual acuity of 20/40 or better was attained in all eyes, and the last recorded visual acuity was 20/40 or better in seven of eight eyes. Early complications included posterior synechiae formation in two eyes, one of which required reoperation. Late complications included visually disabling posterior capsular opacification in one eye and new glaucoma in two eyes. Preoperative corticosteroids were reduced postoperatively in five eyes, were the same in two eyes, and increased in one eye. Persistent postoperative inflammation, posterior synechiae, and a pupillary membrane occurred in one of the children in this study, suggesting that intraocular lens implantation in this age group may have more complications.

Results of this study suggest that, in selected adults, cataracts caused by juvenile rheumatoid arthritis-associated uveitis can be treated by the standard phacoemulsification technique with intraocular lens implantation and can have excellent results. Intraocular lens implantation in children with juvenile rheumatoid arthritis merits further investigation.