Table 1 Incidence of uveitis among JRA children presenting with articular disease No. (Percent) Ocular Involvement Type Pauci Poly Systemic TOTAL 87 47 18 152 (57.2) (31.0) (11.8) 100 1st Visit No. 12 1 1 14 (%) 13.8 2.1 5.6 9.2 Later No. 8 6 3 17 (%) 9.2 12.8 16.7 11.2 % of type No. 20 7 4 31 (%) 23.0 14.9 22.2 – Uveitis and JIA % of all types – 64.5 22.6 12.9 100.0 all types of JIA arthritic manifestations, in 14 children (9.2%), the intraocular inﬂammation (uveitis) was diagnosed during the ﬁrst ophthalmic examination (12/14 had clinical evidence for the pauciarticular type of JIA). All these 14 children had a recent history (3 to 9 months) of arthritic disease. Ten addi- tional children developed uveitis less than three years of the initial ocular examination and, in 7 children the uveitis was detected 3 to 7 years later (Table 1). Among the 20 children presenting initially with uveitis, 19 developed clinical mani- festations compatible with the pauciarticular type of JIA. A systemic type of JIA was conﬁrmed two months after the diagnosis of uveitis in one out of these 20 children (Table 2). Thus, out of a total of 172 children with JIA, 51 children had an associated intraocular inﬂammation (uveitis). Thirty nine of these 51 children (76.5%) had the pauciarticular type of JIA. In 32 of these 39 children (82%), the uveitis was either the presenting symptom or it was detected during the initial ophthalmic examination. On initial examination, the intraocular inﬂammation processes were conﬁned to the anterior segment in 45 of the 51 (88.2%) affected children. In 5 of the affected children (9.8%), a few cells were also observed in the anterior vitre- ous and in one child (2%), a marked vitritis with peripheral retinal vasculitis was observed in one eye. On further follow up however, only in 4 out of the 51 patients (7.8%), the inﬂammatory processes remained strictly conﬁned to the anterior segment. Thus, with time, a tendency towards the involvement of the intermediate and posterior segments was observed. On last ophthalmic examination (3 to 15 years after initial diagnosis), in 22 patients (43.1%) the inﬂammatory signs were detected in all eye segments (pan uveitis) and in 24 children (47%), the inﬂammatory reaction involved the anterior and intermediate segments. When the intraocular inﬂammation was initially diag- nosed, it was uniocular in 29 of the 51 children (56.9%). On further follow up, the intraocular inﬂammation remained uni- ocular only in 8 of the 51 patients (15.7%) while in 43 children (84.3%) there was involvement of both eyes. When both eyes Clinical Ophthalmology 2007:1(4) were affected, the intensity of intraocular inﬂammation was unequal in the majority of patients. The eye with more severe inﬂammation showed invariably a poorer visual acuity and more prominent secondary ocular complications. The ocular complications observed in the 94 affected eyes of the 51 children are illustrated in Table 3. More severe and early complications were observed in girls manifesting the intraocular inﬂammatory processes when 4 years of age or younger. In 46 of the 94 eyes with uveitis (48%), a band-shaped keratopathy developed. In most, the keratopathy was mild and did not interfere with vision. In 5 eyes (5.3%), the keratopathy was dense, encroached on the visual axis and affected the visual acuity. An increased IOP above 24mmHg and possible devel- opment of glaucoma was detected in 24 of the 94, (25%) affected eyes. Medical treatment consisting of beta blockers and carbonic anhydrase inhibitor drops along with a decrease in the instillation frequency of corticosteroid eye drops induced a decrease of IOP below 20 mmHg in all cases. Posterior synechiae and irregular pupil were observed in 64 eyes (68%). Lens opacity interfering with the visual acuity (cataract) was recorded in 56 of the 94 affected eyes (59.6%). In eyes developing severe lens changes (dense cataract) accompa- nied by band keratopathy, marked impairment of the visual functions interfering with the daily activity and/or inducing amblyopia were observed (Table 4). In 30 of the eyes (32%) it was assessed that the lens opacity and/or the ensuing amblyopia were the main cause for the decrease of vision to a level lower Table 2 Type of JRA in children presenting initially with uveitis Type of arthritis Ocular Involvement No. (%) Pauci 19 (95) Poly 0 (0) Systemic 1 (5) TOTAL 20 (100) 515