BenEzra et al Table 3 Ocular complications observed in 94 eyes of the 51 affected children Complication* No. Children (%) No. Eyes (%) Band keratopathy 30 (59) 46 (48) Glaucoma 13 (25) 24 (25) Post. synechia 43 (84) 64 (68) Cataract 22 (43) 56 (59.6) *More than one complication was observed in most eyes. Each of these complica- tions is tabulated separately.Therefore, the total number of observed secondary complications (190) is higher than the total number of eyes. than 0.05 (6/120 or 20/400) (Table 4). Therefore, surgery of the cataract was advised in these cases. Twenty nine of these eyes underwent lensectomy combined with anterior vitrectomy while in one case, the parents declined surgical intervention. An intraocular lens (IOL) was implanted in 19 eyes (pseudophakia) while 10 eyes remained aphakic. Glasses or contact lenses were prescribed for the correction of aphakia in these 10 eyes. Discussion A deﬁnite association exists between the articular and ocular manifestations in children with JIA. The reported incidences of this association vary markedly with lower incidences and less severe ocular disease being reported more recently (Sherry et al 1991; Oren et al 2001; Sim et al 2006; Saurenmann et al 2007). A close look at these published differences reveals that the severity of ocular affection in the various studies is probably associated with population selection and referral trends in speciﬁc medical environments. It appears that the severity of ocular complica- tions is higher when the study authors are ophthalmologists. This tendency is increased further when the papers originate from tertiary clinics specializing in uveitis and surgery of its complications. Noteworthy is the fact that 20 of the 51 children with JIA and uveitis in our cohort presented with severe intra- ocular inﬂammation. The diagnosis of JIA was made only after these children were referred speciﬁcally for pediatric examination to assess the possible presence of JIA. In most of these 20 children the articular disease was of little concern to the children or their parents. They did not seek pediatric care and did not attend a pediatric clinic. Thus, a study regarding the incidence of uveitis in JIA carried out by pediatricians will not include these children biasing the incidence as well as the severity of ocular inﬂammation. Concomitant with other reports (Sim et al 2006; Grassi et al 2007; Henligenhaus et al 2007), we observed in our present study that the highest associated incidence of 516 arthritis and ocular manifestations is found in the group of children with the pauciarticular type. We have also noted that, in many cases, the articular and ocular clinical disease severity do not parallel. In many children, we observed severe ocular exacerbations during quiescent periods of arthritic manifestations and vice versa. An interesting aspect of our study is the observation that during the initial phase of the ocular disease, the inﬂammation is strictly restricted to the anterior segment. Later during the follow up however, the intermediate and posterior segments become involved in the intraocular inﬂammatory processes. These observations may result from a “spill over” of the chronically stimulated inﬂammatory cells from the anterior segment to the posterior structures “dragging” them to react following the release of inﬂammatory cytokines. The major points of clinical interest which can be derived from our study are: 1. Thirty nine of the 51 children with uveitis in our study group (76.5%) had the pauciarticular type of JIA. 2. The majority of children with pauciarticular JIA devel- oping intraocular inﬂammation harbor signs of ocular disease either before or shortly after the development of arthritic manifestations. 3. Most children with polyarticular or systemic JIA types do not present signs of intraocular inﬂammation during the ﬁrst three years following the initial arthritic manifestations. 4. The potential for a child with JIA to develop de novo ocular inﬂammation, at any time during the ophthalmic follow up, is low. The majority of children within all JIA types who devolop an associated uveitis harbor ocular signs on initial examination. Only a minority of these children develop the uveitic signs and symptoms later. Therefore, frequent ophthalmic visits for all children with JIA seems unjustiﬁed. 5. Nearly all children presenting with ocular disease and developing later JIA characteristics, had a mild arthritis involving only one or two joints. Table 4 Best corrected visual acuity (BCVA) in relation to the lenticular changes in the 94 affected eyes* Lenticular changes No. Eyes (%) BCVA** None 38 (40.4) 0.7 ± 0.2 Mild/Moderate 26 (27.7) 0.4 ± 0.3 Severe 30 (31.9) 0.02 ± 0.02 *Recorded on last visit before any corrective surgery was carried out. **BCVA: best corrected visual acuity expressed as decimal scale units eg, 1.0 is a visual acuity of 6/6 or 20/20 and 0.01 is 6/600 or 20/2000. In practical terms, we recorded 0.01 visual acuity level as the ability to perceive light with accurate projection and 0.02 as the ability to perceive hand movements in front of the affected eye. Clinical Ophthalmology 2007:1(4)