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145 EW INTERNATIONAL March 2015 said. "We consider at least 3 months preoperatively as an essential period of total control. The prophylax- is regimen, which we introduce around the time of operation, is and the uveitis was "absolutely controlled." Additionally, IOL implantation was not recommend- ed in patients with pars planitis or lens-induced inflammation, and was contraindicated in patients with JIA-associated uveitis. "Thus it is essential to achieve very tight control of the inflamma- tion preoperatively," Dr. Pavesio usually a combination of topical and increased systemic steroids, apart from maintaining the use of other treatments they have been using, in- cluding immunosuppressive agents and biologics." The failure to achieve strict, long-term control of uveitis may lead to increased postoperative inflammation and its complications including macular edema, hypotony, glaucoma, band keratopathy, cyclitic membranes, retinal detachment, and/or the need to explant the IOL. "The frequency of the steroid drops preoperatively can be main- tained depending on how often they have been used, or it may have to be increased for at least one week preop," Dr. Pavesio said. "Following surgery, the frequency of the drops will be increased to hourly and then tapered according to clinical behavior. Systemic steroids are also increased or introduced a few days before surgery, and this level will be maintained for the first week post- op, followed by a gradual tapering regimen." In the last 2 decades, visual out- comes of uveitis patients undergoing cataract surgery have dramatically improved due to several factors: im- proved medical management (e.g., routine use of immunosuppressive therapy), refined surgical technique, and better IOL design. The growing use of immunotherapies and tar- geted biologic agents where needed in pediatric uveitis have increased the potential to implant lenses and predict outcomes. Not enough supporting evidence While the preferred technique in general cases of uveitis is phacoemulsification, there are no prospective comparative trials evaluating IOL implantation against aphakia in cataract surgery in these patients—only small, uncontrolled, retrospective case series are available in the literature. "The problem in children is that there are other issues to consider," Dr. Pavesio said. "Remember that there are issues that have to do with the anatomy of the eyes of the child, with the IOL power calculation and the challenges with corneal changes, synechia, and the elastic capsule. visit sn.im/op-eye for promotion info@opmarks.com • www.opmarks.com • 866.307.2757 • Economical – Reusable & autoclavable throughout hundreds of procedures • Bright red silicone provides highly recognizable neutral zone • Low proole minimizes blind reaching, reducing the risk of sharps injury • Durable – sufficiently permanent but easily removed post-op with alcohol swab or transpore tape • Visible on all skin tones – white background provides high visibility Ideal for ophthalmic, pediatric & elderly site marking continued on page 146

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