97th DOG Annual Meeting 1999



J. A. Reichelt, B. Nölle, B. Wiechens

Background: Chronic iridocyclitis (CIC) can be an ocular complication in juvenile rheumatoid arthritis (JRA). Often the prognosis is poor due to complications like cataract, vitreous opacities, cystoid macular edema (CME), secondary glaucoma and subsequent optic atrophy. In this retrospective study we evaluated the outcome of pars plana vitrectomy (PPV) in eyes with JRA-associated CIC.

Methods: Between 1988 and 1998 PPV was performed in 16 eyes of 13 patients because of severe vitreous opacities or CME. In 7 of these eyes combined surgery with phakectomy was necessary. The mean age of the patients was 9 years (range 2-26 years). In 2 patients a second PPV was necessary due to macular pucker and vitreous opacities. All patients were regularly examined in our clinic. Two lines difference in visual acuity was defined to be significant. Due to the low age of one patient visual acuity could not be determined in 2 eyes.

Results: Early after surgery, the visual acuity in 13 out of 16 eyes improved. The remaining 3 eyes did not show any change. During long-term follow up, visual acuity improved in 7 out of 16 eyes, in 6 eyes visual acuity was unchanged and in 3 eyes visual acuity deteriorated. In those 14 eyes that showed CME, 11 eyes improved after surgery. The following complications could be observed: retinal detachment (3), secondary glaucoma (2), intraocular hemorrhage (2), vitreous opacity (1), macular pucker (1) and band keratopathy (4).

Conclusions: In patients suffering from JRA-associated CIC pars plana vitrectomy, eventually combined with phakectomy, leads to an improvement of visual acuity and CME. In long-term course the prognosis is often limited due to secondary complications, even if immunosuppressive therapy is maintained.

Department of Ophthalmology, University of Kiel, Hegewischstrasse 2, D-24105 Kiel, Germany