Cataract Surgery in Pediatric Uveitis

Zaborowski, Anthony G.; Quinn, Anthony G.; Dick, Andrew D.

doi:10.3928/01913913-20080901-16

Cited by 15 publications

(6 citation statements)

References 66 publications

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“…Cataracts, particularly in very young children, have a high rate of posterior capsular opacification, long-term risk of glaucoma, and additional challenges if a EVD survivor has had uveitis [ 23 , 24 ]. Because of severe inflammation that may ensue following cataract removal, patients are sometimes left without a lens (i.e.…”

Section: Methodsmentioning

confidence: 99%

Implementation of the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) study: Lessons learned for vision health systems strengthening in Sierra Leone

et al. 2021

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Background Following the West African Ebola virus disease (EVD) outbreak of 2013–2016 and more recent EVD outbreaks in the Democratic Republic of Congo, thousands of EVD survivors are at-risk for sequelae including uveitis, which can lead to unremitting inflammation and vision loss from cataract. Because of the known risk of Ebola virus persistence in ocular fluid and the need to provide vision-restorative, safe cataract surgery, the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study was implemented in Sierra Leone. During implementation of this multi-national study, challenges included regulatory approvals, mobilization, community engagement, infection prevention and control, and collaboration between multiple disciplines. In this report, we address the multifacted approach to address these challenges and the impact of implementation science research to address an urgent clinical subspecialty need in an outbreak setting. Methodology/Principal findings Given the patient care need to develop a protocol to evaluate ocular fluid for Ebola virus RNA persistence prior to cataract surgery, as well as protocols to provide reassurance to ophthalmologists caring for EVD survivors with cataracts, the EVICT study was designed and implemented through the work of the Ministry of Health, Sierra Leone National Eye Programme, and international partnerships. The EVICT study showed that all 50 patients who underwent ocular fluid sampling at 19 and 34 months, respectively, tested negative for Ebola virus RNA. Thirty-four patients underwent successful cataract surgery with visual acuity improvement. Here we describe the methodology for study implementation, challenges encountered, and key issues that impacted EVD vision care in the immediate aftermath of the EVD outbreak. Key aspects of the EVICT study included defining the pertinent questions and clinical need, partnership alignment with key stakeholders, community engagement with EVD survivor associations, in-country and international regulatory approvals, study site design for infection prevention and control, and thorough plans for EVD survivor follow-up care and monitoring. Challenges encountered included patient mobilization owing to transportation routes and distance of patients in rural districts. Strong in-country partnerships and multiple international organizations overcame these challenges so that lessons learned could be applied for future EVD outbreaks in West and Central Africa including EVD outbreaks that are ongoing in Guinea and Democratic Republic of Congo. Conclusions/Significance The EVICT Study showed that cataract surgery with a protocol-driven approach was safe and vision-restorative for EVD survivors, which provided guidance for EVD ophthalmic surgical care. Ophthalmologic care remains a key aspect of the public health response for EVD outbreaks but requires a meticulous, yet partnered approach with international and local in-country partners. Future efforts may build on this framework for clinical care and to improve our understanding of ophthalmic sequelae, develop treatment paradigms for EVD survivors, and strengthen vision health systems in resource-limited settings.

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Section: Methodsmentioning

confidence: 99%

Implementation of the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) study: Lessons learned for vision health systems strengthening in Sierra Leone

et al. 2021

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“…An example of such a measure is an anterior vitrectomy at the time of cataract surgery. Postoperative complications which have been observed in uveitis, sometimes after several months or years of quiescence, include the development of thick secondary retrolental membranes, hypotony, ERM and macular edema [12,13,14,15,16]. …”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Severe Complications Arising from Uveitis in Juvenile Idiopathic Arthritis

Langner-Wegscheider

Smet²

2014

Ophthalmologica

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Purpose: Evaluate outcomes from severe ocular complications of juvenile idiopathic arthritis following surgery. Methods: Eleven eyes of 7 patients underwent complete vitrectomy and peeling of the inner limiting membrane. Inclusion criteria were: anteroposterior segment involvement, hypotony, inflammation control of less than 3 months, compliance issues, rapidly progressive disease. Phacoemulsification was allowed if the patient was >6 years old and inflammation free >3 months. The alternative was a complete lensectomy. Results: Visual acuity improved from a logMAR of 1.48 to 0.37 (p < 0.0001), and 0.20 at 6 and 12 months (p < 0.0001). No flare-up was observed within the first 6 months. Five eyes developed inflammation between 7 and 19 months. Glaucoma developed in 5 eyes at a median of 16 months. No patient developed cystoid macular edema. Conclusion: Extensive pars plana vitrectomy and cataract extraction can lead to significant improvement in visual acuity. Patients continue to require long-term immunosuppression and adequate follow-up.

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“…Historically, these patients had high complications rates due to greater technical difficulty and severe postoperative inflammation. 11 Much of what we know has been borrowed from adult cataract series which highlight that paediatric cases often display complex surgical demands, co-pathologies and worse visual outcomes. 12 However, improvements in surgical outcomes have been attributed to better control of inflammation, improved microsurgical techniques and improvements in IOL materials.…”

Section: Introductionmentioning

confidence: 99%

“…12 However, improvements in surgical outcomes have been attributed to better control of inflammation, improved microsurgical techniques and improvements in IOL materials. 11 In this study, we report our approach to cataract surgery in the setting of paediatric uveitis. Specifically, we assess the optimal timing of surgery with respect to uveitis inactivity and the risk of amblyopia.…”

Section: Introductionmentioning

confidence: 99%

Paediatric cataract in the uveitis setting

O’Rourke

McCreery

Kilmartin

et al. 2020

European Journal of Ophthalmology

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Background/aims: Cataract formation is common in uveitis and is visually more threatening in the paediatric cohort due to the risk of amblyopia. In addition, paediatric uveitis can often be difficult to manage. We report our experience with IOL placement in cataract surgery in the setting of paediatric uveitis. Methods: This non-comparative, retrospective interventional case series examined our cases of paediatric cataract occurring in patients with uveitis from 2003 to 2016. Parameters examined included visual acuity (VA), underlying diagnosis, immunosuppression status, intra-operative complications and requirement for further surgery. Results: In total, 10 eyes of seven patients were identified. The mean age at diagnosis of uveitis was 7.7 years (range 5.2–14 years) with onset of cataract at a mean of 29.3 months later (range 0–66 months). Three cases were bilateral and four cases were unilateral. Final visual outcomes were excellent with 80% showing improvement in VA achieving greater than 6/9.5 ( p < 0.05). These patients had significant co-morbidities with concurrent glaucoma, band keratopathy and cystoid macular oedema. Uveitis was quiet for a minimum of 6 months in all cases prior to surgery with augmentation of immunosuppression pre-operatively as well as intra-operative local or intra-venous steroids. Tight post-operative care was necessary as 80% developed further flare-up of uveitis requiring increased immunosuppression and surgical interventions to manage their uveitis. Conclusion: Paediatric uveitis patients who develop cataract can have good visual outcomes with IOL insertion at the time of surgery when there is aggressive control of uveitis in the pre, peri and post-operative period.

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Cataract Surgery in Pediatric Uveitis

Cited by 15 publications

References 66 publications

Implementation of the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) study: Lessons learned for vision health systems strengthening in Sierra Leone

Implementation of the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) study: Lessons learned for vision health systems strengthening in Sierra Leone

Surgical Management of Severe Complications Arising from Uveitis in Juvenile Idiopathic Arthritis

Paediatric cataract in the uveitis setting

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