The paradox of intraocular lens tolerance in juvenile idiopathic arthritis-associated uveitis: A case of asymmetry in a 6-year-old child

We report the case of a 6-year-old boy with oligoarticular juvenile idiopathic arthritis (JIA)-associated uveitis and positive antinuclear antibody who developed bilateral cataracts and underwent cataract surgery with intraocular lens (IOL) implantation in both eyes under systemic immunosuppressive therapy. Despite optimal therapy, postoperative outcomes were markedly different between the eyes. The right eye developed severe complications including fibrin formation, extreme photophobia, and IOL cocooning, ultimately requiring IOL explantation and pars plana vitrectomy. In contrast, the left eye experienced minimal inflammation and no major postoperative issues. The visual acuity improved to 6/24 in the right eye following surgical intervention and continued immunosuppression, while the left eye maintained stable vision at 6/9. A subsequent flare-up of inflammation and posterior capsular opacification in the left eye was managed with YAG capsulotomy and adjustment of adalimumab frequency. This case highlights the challenges of cataract surgery in JIA-associated uveitis and highlights the need for individualized surgical decisions and close monitoring due to the unpredictable, asymmetric inflammatory response, even under adequate immunosuppression.