Paediatric cataract in the uveitis setting

O’Rourke, Micheal; McCreery, Kathryn; Kilmartin, Dara J.; Brosnahan, Donal

doi:10.1177/1120672120962059

Cited by 11 publications

(30 citation statements)

References 27 publications

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“…Taken together, studies found that cataract surgery, regardless of IOL implantation, generally improved vision. Nearly all studies specifically highlighted the need for intensive immunosuppressive treatment and control of uveitis after cataract surgery, but it was unclear whether it was a question of sustaining preexisting regimen or based on a change in the need for controlling the uveitis [16,20,21,[32][33][34][35][36].…”

Section: Results Of Individual Studies and Risk Of Bias Within Studiesmentioning

confidence: 99%

“…Nine studies provided eligible and comparable data for the meta-analyses [16,20,21,30,[32][33][34][35][36]. ese studies collectively summarized data on 256 eyes: 153 eyes underwent IOL implantation and 103 eyes were aphakic.…”

Section: Synthesis Of Results In Meta-analyses and Risk Of Bias Across Studiesmentioning

confidence: 99%

“…Eight studies provided relevant data for the primary outcome [16,20,21,[32][33][34][35][36]. O'Rourke et al [34] provided only data on a single eye with aphakia, which leads to SD � 0, and therefore this study was ineligible for the meta-analysis for analytical reasons [34]. us, seven studies were included for the meta-analyses of the primary outcome [16,20,21,32,33,35,36].…”

Section: Synthesis Of Results In Meta-analyses and Risk Of Bias Across Studiesmentioning

confidence: 99%

“…ree studies reported that the uveitis was quiescent 3 months prior to surgery in all eyes [21,35,36], one study reported that the uveitis was inactive in 6 months prior to surgery [34], and one study reported absence of inflammation in 3 months prior to surgery except one eye with absence of inflammation for 2 months [33].…”

Section: Study Characteristicsmentioning

confidence: 99%

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Cataract Surgery with or without Intraocular Lens Implantation in Pediatric Uveitis: A Systematic Review with Meta-Analyses

Schmidt

Al‐Bakri

Rasul

et al. 2021

Journal of Ophthalmology

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Purpose. To systematically review the results of comparative studies of modern cataract surgery in pediatric uveitis with or without intraocular lens (IOL) implantation and to perform comparative meta-analyses to compare visual acuity outcomes and complication rates. Methods. On 12 November 2020, we systematically searched the Cochrane Central, PubMed/MEDLINE, EMBASE, ClinicalTrials.gov, and all affiliated databases of the Web of Science. Two authors independently reviewed studies and extracted data. Studies were reviewed qualitatively in text and quantitatively with meta-analyses. Outcome measures were preoperative and postoperative best-corrected visual acuity (BCVA), inflammation control, and rates of postoperative complications. Results. Ten studies of 288 eyes were eligible for review of which the majority were eyes with juvenile idiopathic arthritis-associated uveitis. Summary estimates revealed that the BCVA was better in pseudophakic eyes vs. aphakic eyes (1-year postoperative: −0.23 logMAR, 95% CI: −0.43 to −0.03 logMAR, P = 0.027 ; 5-year postoperative: −0.35 logMAR, 95% CI: −0.51 to −0.18 logMAR, P = 0.000036 ). Pseudophakic eyes had more visual axis opacification (OR 6.76, 95% CI: 2.73 to 16.8, P = 0.000036 ) and less hypotony (OR 0.19, 95% CI: 0.04 to 0.95, P = 0.044 ). Conclusions. In modern era cataract surgery on eyes with pediatric uveitis with IOL implantation leads to satisfactory and superior visual outcomes and no differences in complication rates apart from an increased prevalence of visual axis opacification and a decreased prevalence of hypotony when compared to aphakia. However, limitations of the retrospective design and the presence of selection bias necessitate a careful interpretation.

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Section: Results Of Individual Studies and Risk Of Bias Within Studiesmentioning

confidence: 99%

Section: Synthesis Of Results In Meta-analyses and Risk Of Bias Across Studiesmentioning

confidence: 99%

Section: Synthesis Of Results In Meta-analyses and Risk Of Bias Across Studiesmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Cataract Surgery with or without Intraocular Lens Implantation in Pediatric Uveitis: A Systematic Review with Meta-Analyses

Schmidt

Al‐Bakri

Rasul

et al. 2021

Journal of Ophthalmology

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“…Nowadays, cataract surgery with IOL implantation may be considered in well-selected children affected by JIA-associated uveitis, providing adequate immunosuppression with zero tolerance of inflammation [ 22 , 24 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Cataract Surgery with Intraocular Lens Implantation in Juvenile Idiopathic Arthritis-Associated Uveitis: Outcomes in the Era of Biological Therapy

Bolletta

Coassin

Iannetta

et al. 2021

JCM

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This study compared the outcomes of cataract surgery with intraocular lens (IOL) implantation in patients with juvenile idiopathic arthritis (JIA)-associated chronic anterior uveitis treated with antimetabolite drugs and systemic corticosteroids (Non-Biological Group) versus patients treated with antimetabolites and biological drugs (Biological Group). A cohort of patients with cataract in JIA-associated uveitis undergoing phacoemulsification with IOL implantation was retrospectively evaluated. The main outcome was a change in corrected distance visual acuity (CDVA) in the two groups. Ocular and systemic complications were also recorded. The data were collected preoperatively and at 1, 12, and 48 months after surgery. Thirty-two eyes of 24 children were included: 10 eyes in the Non-Biological Group and 22 eyes in the Biological Group. The mean CDVA improved from 1.19 ± 0.72 logMAR preoperatively to 0.98 ± 0.97 logMAR at 48 months (p = 0.45) in the Non-Biological Group and from 1.55 ± 0.91 logMAR preoperatively to 0.57 ± 0.83 logMAR at 48 months (p = 0.001) in the Biological Group. The postoperative complications, including synechiae, cyclitic membrane, IOL explantation, glaucoma, and macular edema, were not statistically different between the two groups. An immunosuppressive treatment with biological drugs can improve the visual outcome after cataract surgery in patients with JIA-associated uveitis, but it does not significantly reduce postoperative ocular complications.

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Cataract Development Among Pediatric Patients With Uveitis

Hsu,

Kuo,

Lin

et al. 2024

JAMA Netw Open

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ImportanceThe long-term estimated risk of development of cataracts among pediatric patients with uveitis is not clear.ObjectiveTo describe factors associated with the development of cataracts among pediatric patients with uveitis.Design, Setting, and ParticipantsThis cohort study used the international TriNetX database to enroll pediatric patients with and without uveitis from January 1, 2002, to December 31, 2022. The nonuveitis cohort consisted of randomly selected control patients matched by age, sex, race and ethnicity, and specific comorbidities.ExposureDiagnosis of uveitis, identified using diagnostic codes.Main Outcomes and MeasuresThe primary outcome was the risk of developing cataracts among the uveitis group compared with the nonuveitis comparison group, with hazard ratios (HRs) and 95% CIs reported.ResultsA total of 22 687 pediatric patients with uveitis (mean [SD] age, 10.3 [5.6] years; 54.2% male) and 22 687 comparators without uveitis (mean [SD] age, 10.3 [5.6] years; 54.5% male) were enrolled in the study. The risk of cataracts was increased among pediatric patients with uveitis up to a follow-up duration of 20 years (HR, 17.17; 95%CI, 12.90-22.80) from the index date. Subgroup analyses revealed an elevated cataract risk across age groups: 0 to 6 years (HR, 19.09; 95% CI, 10.10-36.00), 7 to 12 years (HR, 27.16; 95% CI, 15.59-47.20), and 13 to 18 years (HR, 13.39; 95% CI, 8.84-20.30); both female sex (HR, 13.76; 95% CI, 9.60-19.71) and male sex (HR, 11.97; 95% CI, 8.47-16.91); and Asian (HR, 13.80; 95% CI, 3.28-58.07), Black or African American (HR, 10.41; 95% CI, 5.60-19.36), and White (HR, 15.82; 95% CI, 11.05-22.60) race. Furthermore, increased cataract risks were also observed among those with and without a history of immunosuppressive agents (with: HR, 26.52 [95% CI, 16.75-41.90]; without: HR, 17.69 [95% CI: 11.39-27.40]), a history of steroid eye drop use (with: HR, 29.51 [95% CI, 14.56-59.70]; without: HR, 16.49 [95% CI, 11.92-22.70]), and a history of intraocular procedures (with: HR, 11.07 [95%CI, 4.42-27.71]; without: HR, 14.49 [95% CI, 10.11-20.70]).Conclusions and RelevanceIn this cohort study of pediatric patients with uveitis, an elevated risk of cataracts following a uveitis diagnosis was found compared with pediatric patients without uveitis. The findings suggest that pediatric patients with uveitis should be monitored for cataract development.

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Paediatric cataract in the uveitis setting

Cited by 11 publications

References 27 publications

Cataract Surgery with or without Intraocular Lens Implantation in Pediatric Uveitis: A Systematic Review with Meta-Analyses

Cataract Surgery with or without Intraocular Lens Implantation in Pediatric Uveitis: A Systematic Review with Meta-Analyses

Cataract Surgery with Intraocular Lens Implantation in Juvenile Idiopathic Arthritis-Associated Uveitis: Outcomes in the Era of Biological Therapy

Cataract Development Among Pediatric Patients With Uveitis

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