Posters

Effectiveness of intensive perioperative immunosuppression in severe juvenile idiopathic arthritis-associated uveitis undergoing cataract surgery with IOL implantation

Poster Details

First Author: A.Lula ALBANIA

Co Author(s):    R. Bulaj                    

Abstract Details

Purpose:

To report that post-operative outcome of cataract surgery with IOL implantation in patients with severe Juvenile Idiopathic Arthritis-associated uveitis could have excellent results if adequate peri-operative immunosuppression would be applied. Cataract is a common complication of any pattern of uveitis (affecting 20-30% of patients with JIA) with an increased risk of surgery and lower success rates of visual rehabilitation, associated with increased need for longer follow-up; however, control of inflammation with intensive peri-operative steroid regimens indicates that excellent results can be achieved even in severe cases.

Setting:

University Hospital Centre “Mother Theresa”, Department of Ophthalmology, Tirana, Albania

Methods:

This is a case report of a 10 year old patient diagnosed with severe JIA-associated uveitis who underwent cataract surgery with IOL implantation in both eyes after aggressive immunosuppression. The diagnosis of JIA-associated uveitis was based on: a. Visual Acuity – RVA 6/36 and LVA 6/30, b. systemic features – ANA-positivity and arthritis, c. ocular manifestations – cataract, +3 AC cells, band keratopathy and posterior synechia. Uveitis was treated with peri-operative steroids to reduce the risk of intra/postoperative complications; treatment consisted in the pre-operative administration of 0.5mg/kg/day Prednisolone (tapered after surgery) and intra-operative Triamcinolone, followed by post-operative topical Dexamethasone.

Results:

Bilateral cataract surgery with IOL implantation following the application of this steroid regimen resulted in a significant improvement of BCVA, respectively RVA 6/9 and LVA 6/6. Intensive immunosuppression showed extremely effective results, achieving excellent control of inflammation (no presence of AC cells), reducing the risk of post-operative CMO and minimizing the risk of exacerbation of uveitis. Posterior capsular opacification (PCO) developed in the right eye and was treated with YAG-laser capsulotomy 7 months after surgery, while steroid-induced ocular hypertension was noted in the left eye and was treated with IOP lowering medications.

Conclusions:

Although there is no universal immunosuppressive regimen for the treatment of JIA-associated uveitis undergoing cataract surgery with IOL implantation, intensive peri-operative steroid cover should be considered as a very effective alternative in improving the post-operative outcome and reducing the risk of inflammation-related complications. However, long-term safety is still unknown, especially in severe cases, indicating that close observation and frequent follow-ups of patients with this condition undergoing cataract surgery is required to reduce the risk of vision loss and prevent permanent damage of visual function.

Financial Disclosure:

None