Eyeworld

EW INTERNATIONAL 144 March 2015 by Matt Young and Gloria D. Gamat EyeWorld Contributing Writers U nlike in adult uveitic pa- tients, the surgical man- agement of uveitic cataract in children is both chal- lenging and controversial, and the surgery itself has historically been associated with poor visual outcomes. "There is a wide range of possi- ble abnormalities that can develop in anyone suffering from uveitis," said Carlos Pavesio, MD, consultant ophthalmic surgeon, Moorfields Eye Hospital, London, who spoke at the National Healthcare Group (NHG) Eye Institute 7th International Oph- thalmology Congress in Singapore. "Some of the problems with the disease is that it is a chronic disease, the inflammation is ongoing, and of course there is the very long-term use of therapy, especially steroids, topically or systematically." In particular, juvenile idiopathic arthritis (JIA)- or juvenile rheuma- toid arthritis (JRA)-associated uveitis poses unique therapeutic challenges to the clinician, and correction of aphakia in these types of patients remains a debatable issue. "In younger children, the younger they are manifesting their arthritis, the more likely they will develop uveitis, and this is also likely to be more severe," Dr. Pavesio said. "These children tend to be identified by the time they already have sequelae. So it is very import- ant to work alongside the pediatri- cian and pediatric rheumatologist for proper follow-up of screening protocols." Challenges In general, cataract surgery in uve- itic patients is challenging, but in children, according to Dr. Pavesio, there are added challenges. While IOL implantation is routine in the majority of phacoemulsification procedures, it may be problematic in patients with some forms of ocular inflammation. "The challenge is in the inflam- mation," Dr. Pavesio said. "We have to keep in mind all the possible problems related to the inflamma- tion in terms of etiology, the age of the patient, the duration of the inflammation, ongoing systemic therapy, and the degree of control of inflammation, which is very important, also keeping in mind the fact that in young children vision is still developing and amblyopia can become another serious problem." Various uncontrolled reports suggest that phaco with IOL implan- tation can be safely performed when uveitis is managed by an appropriate anti-inflammatory regimen. In a 1990 extensive review of IOL implantation in uveitic patients, Hooper et al indicated that IOL implantation could be considered in patients with Fuchs' heteroch- romic iridocyclitis (FHI) or chronic non-granulomatous uveitis of any cause, if there were no synechiae Challenges of cataract surgery in pediatric uveitic patients visit sn.im/eyeworld for promotion info13@viscot.com • www.viscot.com • 800.221.0658 #1451 The standard in correct site marking. The Mini Surgical Skin Marker • Economical - upwards of 50% - 75% less than full size markers! • Sized for single patient use • Available sterile and non-sterile #1425 #1424 Surgical markers for precise lines

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