Pars plana lensectomy in cases of cataract with juvenile chronic uveitis

Classical cataract extraction in young patients with secondary cataract following juvenile chronic uveitis often is complicated by serious problems such as severe postoperative uveitis, hypotonia oculi and phthisis bulbi. Lensectomy with partial anterior vitrectomy might be a less inflammatory way of handling these cases.

Over a 15-year period we have treated 10 eyes of 9 young patients (age from 8 to 30 years) with secondary cataract after chronic uveitis by pars plana lensectomy with partial anterior vitrectomy. A classical two-port technique was used with incisions at 4 mm from the limbus. The follow-up period varied from 3 to 12 years with an average of 8 years. There were five patients with chronic iridocyclitis, two with Fuch's heterochromic irridocyclitis, one with sympathetic ophthalmia and one with idiopathic panuveitis.

Seven eyes were corrected with contact lenses. During the entire follow-up period six had 20/20 visual acuity and one, 20/40. None of these patients reported tolerance problems with the contact lens. One patient has 20/20 visual acuity with spectacles. One patient who initially had 20/20 visual acuity with a contact lens developed retinal detachment 2 years after surgery, during pregnancy, and now has 20/40 vision after retinal surgery. She prefers not to wear the contact lens any longer because of diplopia. The visual acuity of one patient was no better than hand movement and his aphakia was never corrected. Complications included one vitreous haemorrhage necessitating a second vitrectomy, one retinal detachment during pregnancy and one retinal detachment with proliferative vitreoretinopathy. One patient with sympathetic ophthalmia has 20/20 vision after 9 years' follow-up but still needs systemic steroids and cyclosporine.

Pars plana lensectomy, with anterior vitrectomy appears to be a relative safe way to treat secondary cataract in patients during the first 30 years of life.