Probst L E, Holland E J
Department of Ophthalmology, University of Minnesota, Minneapolis 55455-0501, USA.
Am J Ophthalmol. 1996 Aug;122(2):161-70. doi: 10.1016/s0002-9394(14)72007-0.
To study intraocular lens implantation in patients with cataracts associated with juvenile rheumatoid arthritis.
We reviewed the records of seven patients (eight eyes) with juvenile rheumatoid arthritis who had undergone cataract extraction by phacoemulsification with intraocular lens implantation. Initial and final visual acuities, preoperative and postoperative medications, and early and late complications were recorded.
Posterior subcapsular cataracts and non-visually disabling peripheral band keratopathy were found in all eyes. The median postoperative follow-up was 17.5 months (mean, 16.6 months; range, nine to 36 months). Five patients were adults, and two patients were less than 10 years old. A best-corrected visual acuity of 20/40 or better was attained in all eyes, and the last recorded visual acuity was 20/40 or better in seven of eight eyes. Early complications included posterior synechiae formation in two eyes, one of which required reoperation. Late complications included visually disabling posterior capsular opacification in one eye and new glaucoma in two eyes. Preoperative corticosteroids were reduced postoperatively in five eyes, were the same in two eyes, and increased in one eye. Persistent postoperative inflammation, posterior synechiae, and a pupillary membrane occurred in one of the children in this study, suggesting that intraocular lens implantation in this age group may have more complications.
Results of this study suggest that, in selected adults, cataracts caused by juvenile rheumatoid arthritis-associated uveitis can be treated by the standard phacoemulsification technique with intraocular lens implantation and can have excellent results. Intraocular lens implantation in children with juvenile rheumatoid arthritis merits further investigation.
研究青少年类风湿性关节炎相关白内障患者的人工晶状体植入术。
我们回顾了7例（8只眼）青少年类风湿性关节炎患者的病历，这些患者接受了白内障超声乳化吸除联合人工晶状体植入术。记录初始和最终视力、术前和术后用药情况以及早期和晚期并发症。
所有眼中均发现后囊下白内障和无视力障碍的周边带状角膜病变。术后中位随访时间为17.5个月（平均16.6个月；范围9至36个月）。5例患者为成年人，2例患者年龄小于10岁。所有眼的最佳矫正视力均达到20/40或更好，8只眼中有7只最后记录的视力为20/40或更好。早期并发症包括2只眼出现后粘连，其中1只眼需要再次手术。晚期并发症包括1只眼出现导致视力障碍的后囊膜混浊和2只眼出现新的青光眼。5只眼术后减少了术前使用的皮质类固醇，2只眼相同，1只眼增加。本研究中的1名儿童出现了持续性术后炎症、后粘连和瞳孔膜，提示该年龄组人工晶状体植入可能有更多并发症。
本研究结果表明，在选定的成年人中，青少年类风湿性关节炎相关葡萄膜炎引起的白内障可以通过标准的超声乳化技术联合人工晶状体植入进行治疗，并且可以取得优异的效果。青少年类风湿性关节炎患儿的人工晶状体植入值得进一步研究。
