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Cataract Surgery in Childhood Uveitis

Children with chronic anterior uveitis develop cataract in approximately 40% to 60% of cases during the course of the disease. Cataract is more common in the pediatric population than in adult. In a recent study based on a cohort of 148 children with uveitis, cataract could be predicted to occur at a rate of 0.16 events per patient-year of follow-up. An increased risk for development of cataract is noted in chronic course of uveitis, fibrin formation, long-term and high-dose corticosteroid treatment, and after pars plana vitrectomy (PPV). Surgical treatment of cataract remains a challenging issue for ophthalmologists, and surgeons vary greatly in their recommendations. Surgery was previously performed without intraocular lens (IOL) implantation. Lensectomy/vitrectomy, phacoemulsification through a limbal incision, followed by anterior or PPV and finally standard phacoemulsification techniques associated with posterior capsulorhexis, anterior vitrectomy, and IOL implantation in some cases, represent the 3 main technical procedures. Pediatric cataract surgery and aphakia correction have changed dramatically in recent years. However, even without uveitis, secondary ocular inflammation occurs in children. Acute intraocular inflammation, posterior synechiae, glaucoma, and macular edema seem to be major postoperative complications. Secondary cataract occurs in 18% of children with juvenile idiopathic arthritis ( JIA)-associated uveitis after a follow-up period of 1 year. Children with JIA seem to be at greater risk of ocular complications than