EPOS

European Paediatric Ophthalmological Society

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Cataract surgery in paediatric uveitis

Dureau Pascal¹, Massé Hélène¹, Audren François¹, Terrada Céline², Bodaghi Bahram², Caputo Georges^1
1Fondation Rothschild 25 rue Manin 75019 Paris, France, ²Hôpital Pitié-Salpètrière 47 bd de l'Hôpital 75013 Paris France

Introduction:Uveitis in children, often related to juvenile idiopathic arthritis, can lead to a cataract. The aetiology is generally a combination of the inflammation itself and steroid treatment. The surgical technique remains debated. The goal of this study was to illustrate the indications for surgery, the technique and the prognosis in these high risk eyes. Methods:Retrospective study of 14 eyes of 10 children operated from 2005 to 2007. The following points were noted: Aetiology of uveitis, preoperative visual acuity and anatomy, surgical technique, perioperative treatment, anatomical and functional results. Results:Mean age at the time of surgery was 6.3 years (2 months-9.5 years). Juvenile idiopathic arthritis was the main aetiology. Preoperative VA was inferior to 0.3 in all cases. Preoperative slit-lamp examination revealed a total cataract with circumferential iridolenticular synechiae in all cases, band keratopathy in 8 eyes. The surgical technique consisted of iris retractors, blue vision, anterior capsulorhexis, bimanual lens aspiration. An acrylic hydrophobic IOL was implanted in 10 eyes. A general and local intensive perioperative steroid therapy was given in every case. Four eyes experienced a severe postoperative inflammation despite this treatment. Visual acuity after a mean 10 months follow-up was poor (<0.2) in 4 eyes, median (0.2-0.4) in 4 eyes, and good (> 0.4) in 6 eyes. Conclusion:Bimanual lens aspiration is effective for cataracts in paediatric uveitis. In-the-bag implantation improves the visual prognosis but requires a strict perioperative control of inflammation, by the mean of steroids and in some cases immunosuppressive treatments.