Causes of reduced visual acuity on long-term follow-up after cataract extraction in patients with uveitis and juvenile rheumatoid arthritis.

We reviewed the long-term follow-up on a consecutive series of 16 eyes from ten patients with juvenile rheumatoid arthritis-associated cataracts that were removed by using pars plana lensectomy and vitrectomy. All patients had prominent cataracts, chronic uveitis, posterior synechiae, and vitreitis preoperatively, and had at least 12 months of follow-up postoperatively. The median length of follow-up was 51 months (range, 12 months to ten years). In the early postoperative period, a visual acuity of 20/70 or better was obtained in 13 of 16 eyes (81%). With longer follow-up, the final visual acuity was 20/70 or better in only nine of 16 eyes (56%). The primary categories of delayed visual loss in these cases were glaucoma and macular disease (chronic cystoid macular edema, macular hole, hypotony maculopathy, and recurrent macular pucker). Despite these limitations in maintaining good visual acuity, a pars plana lensectomy and vitrectomy approach is effective for cataracts in these patients with uveitis.