PARS-PLANA LENSECTOMY IN CASES OF CATARACT WITH JUVENILE CHRONIC UVEITIS

Background: Classical cataract extraction in young patients with secon dary cataract following juvenile chronic uveitis often is complicated by serious problems such as severe postoperative uveitis. hypotonia oc uli and phthisis bulbi. Lensectomy with partial anterior vitrectomy mi ght be a less inflammatory way of handling these cases. Methods: Over a 15-year period we have treated 10 eyes of 9 young patients (age from 8 to 30 years) with secondary cataract after chronic uveitis by pars plana lensectomy with partial anterior vitrectomy. A classical two-por t technique was used with incisions at 4 mm from the limbus. The follo w-up period varied from 3 to 12 years with an average of 8 years. Ther e were five patients with chronic iridocyclitis, two with Fuch's heter ochromic iridocyclitis, one with sympathetic ophthalmia and one with i diopathic panuveitis. Results: Seven eyes were corrected with contact lenses, During the entire follow-up period six had 20/20 visual acuity and one, 20/40. None of these patients reported tolerance problems wi th the contact lens. One patient has 20/20 visual acuity with spectacl es. One patient who initially had 20/20 visual acuity with a contact l ens developed retinal detachment 2 years after surgery. during pregnan cy, and now has 20/40 vision after retinal surgery, She prefers not to wear the contact lens any longer because of diplopia. The visual acui ty of one patient was no better than hand movement and his aphakia was never corrected. Complications included one vitreous haemorrhage nece ssitating a second vitrectomy, one retinal detachment during pregnancy and one retinal detachment with proliferative vitreoretinopathy. One patient with sympathetic ophthalmia has 20/20 vision after 9 years' fo llow-up but still needs systemic steroids and cyclosporine. Conclusion : Pars plana lensectomy, with anterior vitrectomy appears to he a rela tive safe way to treat secondary cataract in patients during the first 30 years of life.