Risk of corticosteroid-induced cataract is dose dependent in JIA-associated uveitis

The authors of this retrospective cohort study investigated the risk of cataract development among patients with juvenile idiopathic arthritis (JIA)-associated uveitis treated with topical corticosteroids.

They reviewed the charts of 75 patients with JIA-associated uveitis seen from July 1984 through August 2005 at one academic center and analyzed risk factors for cataract development. Patients were followed for a median of four years.

Incidence of new-onset cataract was 0.04/eye-year. Among the 40 patients (60 eyes) treated with topical corticosteroid therapy, there was a dose-dependent increase in the rate of cataract development. Cataract incidence was 0.01/eye-year for eyes treated with three drops or fewer daily and 0.16/eye-year for eyes treated with more than three drops daily. Among eyes receiving two drops or fewer daily, cataract incidence was 0/eye-year.

Presence of posterior synechiae, active uveitis and use of topical corticosteroids at presentation were significantly associated with cataract development after controlling for confounding variables. Use of topical corticosteroids was associated with cataract formation independent of uveitis activity. Using longitudinal data analysis and controlling for duration of uveitis, presence and degree of active uveitis and concomitant use of other forms of corticosteroids in a time-updated fashion, treatment with up to three drops daily of topical corticosteroid was associated with an 87 percent lower risk of cataract formation compared with eyes treated with more than three drops daily (P = 0.02).

The authors conclude that their data imply that in the setting of suppressed uveitis, patients with JIA-associated chronic anterior uveitis may be treated with up to three drops daily of topical corticosteroids over moderate periods with a low risk of developing cataract.

This paper provides clinicians with data they can use to advise parents and patients based on presenting characteristics. The increased cataract risk can be communicated to parents of patients presenting with posterior synechiae. The study's results emphasize the importance of close follow-up of JIA patients on treatment and attention to titration of topical steroids to the minimal dose necessary to control inflammation. Future prospective studies should address the risks and benefits of treatment versus total control of inflammation.