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TitleIntumescent Cataract as the First Presenting Sign of Juvenile Idiopathic Arthritis: Report of Two Cases
PurposeClassically, Juvenile idiopathic arthritis-associated uveitis (JIA-U) presents as asymptomatic bilateral chronic anterior uveitis. The presence of complications on first presentation correlate with a more severe disease process and a poorer visual prognosis. Cataract is uncommonly found at presentation, and severity has yet to be described.
MethodsWe report two cases of children who presented with intumescent cataract and iris bombe as the first manifestation of JIA.
ResultsTwo girls, aged 12 and 5, were first examined at community clinics due to a decrease in vision. At baseline, both had bilateral active anterior uveitis and unilateral intumescent cataract, extensive posterior synechiae, iris bombe, shallow anterior chamber and increased intra-ocular pressure (IOP). The vision in the more severely affected eye was light perception. The patients were laterdiagnosed with JIA. Both patients were started on topical and systemic treatment. Patient #1 responded well to the treatment and after 4 months with no active inflammation, underwent cataract surgery. Patient #2 had relative afferent pupillary defect, indicating optic neuropathy, at baseline. She continued to have IOP spikes, as high as 46 mmHg. Due to the urgent need to lower the pressure in the already compromised eye, she underwent cataract surgery. At 5 months post-operatively, both patients showed improvement, and inflammation has been inactive since the surgeries.
ConclusionTo our knowledge, this is the first account of intumescent cataract as the presenting sign of JIA-U, or indeed, JIA.
Conflict of interestNo
Authors 1
Last namePILLAR
Initials of first name(s)S
DepartmentDepartment of Ophthalmology, Hadassah Medical Center
Authors 2
Last nameAmer
Initials of first name(s)R
DepartmentDepartment of Ophthalmology, Hadassah Medical Center