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Kolosky TD, Saga AU, Dariano DF, Das U, Panchal BK, Bregman JA, Levin MR, Alexander JL. Comparison of angle-to-angle distance and corneal diameter in pediatric eyes using ultrasound biomicroscopy. PLoS One 2024; 19:e0305624. [PMID: 38889111 PMCID: PMC11185497 DOI: 10.1371/journal.pone.0305624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE To investigate the relationship between corneal diameter and internal corneal span determined from angle-to-angle distance using ultrasound biomicroscopy (UBM) in an observational cross-sectional patient population comprised of 54 eyes (28 healthy control eyes, ages 0.1 to 11.3 years; 26 eyes with primary congenital glaucoma, ages 0.1 to 3.5 years) from 41 pediatric participants ages 0.1 to 11.3 years (mean age: 3±3 years, median age: 2 years). METHODS Forty cornea photographs with reference ruler and 110 UBM images were obtained. Three observers measured horizontal and vertical corneal diameter and angle-to-angle distance in each cornea photo and UBM image using ImageJ and the average values were used. Main outcome measures were Pearson correlation coefficient, linear regression, mean difference between corneal diameter and angle-to-angle distance, and intra-class correlation coefficients among measurements from all three observers for each parameter. RESULTS Corneal diameter and angle-to-angle distance had a strong positive correlation horizontally (Pearson r = 0.89, p<0.001) and vertically (r = 0.93, p<0.001). Correlation was consistent regardless of presence of primary congenital glaucoma and participant age. Regression analysis demonstrated a linear relationship between the parameters for horizontal (CD = 0.99*AA+0.28, R2 = 0.81, p<0.001) and vertical (CD = 0.91 *AA+1.32, R2 = 0.85, p<0.001) dimensions. Overall, reliability was good-excellent, ranging from an ICC of 0.76 for vertical corneal diameter to 0.90 for horizontal angle-to-angle distance. CONCLUSIONS Based on the strong positive correlation found between corneal diameter and angle-to-angle distance in our study population, UBM image analysis can be used to accurately estimate corneal diameter from angle-to-angle distance in children with healthy eyes and primary congenital glaucoma. UBM may provide a useful intraocular alternative for estimating corneal diameter and monitoring diseases that affect the cornea in infants and children, such as congenital glaucoma.
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Affiliation(s)
- Taylor D. Kolosky
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Anusha U. Saga
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, United States of America
| | - Donald F. Dariano
- Department of Biochemistry and Molecular Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Urjita Das
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Bhakti K. Panchal
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jana A. Bregman
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Moran R. Levin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Janet Leath Alexander
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Yoo L, Kadambi N, Bohnsack BL. Corneal characteristics and OCT-angiography findings in pediatric glaucoma and glaucoma suspects. J AAPOS 2023; 27:327.e1-327.e6. [PMID: 37913864 DOI: 10.1016/j.jaapos.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To analyze corneal biomechanics, specular microscopy, and optical coherence tomography-angiography findings in children with glaucoma. METHODS Pediatric patients (<18 years of age) with glaucoma (n = 38), increased cup:disk ratio and normal intraocular pressure (IOP) glaucoma suspects (n = 36), and controls (n = 67) were prospectively enrolled. Patients underwent testing with Ocular Response Analyzer, CellChek Specular Microscope, and Heidelberg OCT-A. RESULTS Average age of participants was 12.4 ± 3.5 years, with no difference between groups (P = 0.71). Glaucoma patients had undergone more intraocular surgeries (P < 0.0001) and showed worse logMAR visual acuity (P < 0.0001) than suspects or controls. Central corneal thickness (CCT) was greater in glaucoma patients (642.8 ± 85.9 μm [P < 0.0001]) and suspects (588 ± 43.7 μm [P = 0.003]) compared with controls (561 ± 39.9 μm). Corneal hysteresis (CH) was decreased in eyes with glaucoma (10.4 ± 3.0) compared with controls (11.7 ± 1.5 [P = 0.006]), but not suspects (11.3 ± 2.0 [P = 0.1]). Glaucoma patients had lower endothelial cell density (2028.4 ± 862.7 [P < 0.0001]) and greater average cell area (547.2 ± 332.4 [P < 0.0005]) compared with suspects (2919.3 ± 319.1, 347.5 ± 46.2) and controls (2913.7 ± 399.2, 350.8 ± 57.7), but there was no difference in polymegathism (P = 0.12) or pleomorphism (P = 0.85). No differences in vessel density or vessel skeletal density in the retinal vascular complex (P = 0.3077, P = 0.6471) or choroidal vascular complex (P = 0.3816, P = 0.7306) were detected. CONCLUSIONS Children with glaucoma showed thicker corneas with lower endothelial cell density and greater cell area, but no difference in retinal/choroidal vascular densities compared with suspects and controls.
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Affiliation(s)
- Lauren Yoo
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Namrata Kadambi
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brenda L Bohnsack
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois.
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Wood KS, Ye E, Trivedi RH, Wilson ME. Preoperative central corneal thickness in eyes with pediatric cataract versus normal fellow eyes. J AAPOS 2023; 27:87.e1-87.e4. [PMID: 36871929 DOI: 10.1016/j.jaapos.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/22/2022] [Accepted: 01/02/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE To compare the preoperative central corneal thickness (CCT) in eyes with unilateral cataract with their normal fellow eyes in the pediatric population. METHODS A retrospective chart review was conducted using the STORM Kids cataract database. Eyes with traumatic cataract, previous surgery or therapeutic manipulation, or age >18 years were excluded. Only eyes with a normal fellow eye were included. The intraocular pressure, age at time of surgery, race, sex, and type of cataract were also extracted from the record. RESULTS A total of 70 eyes with unilateral cataract and 70 fellow normal eyes met inclusion criteria. The mean age at the time of surgery was 3.35 years (range, 0.08-15.05). The mean preoperative CCT in the operated eyes was 577 ± 58 μm (range, 464-898 μm). The mean preoperative CCT in fellow eyes was 570 ± 35 μm (range, 485-643 μm). There was no statistically significant difference between the preoperative CCT in cataract eyes versus unaffected fellow eyes (P = 0.183). When stratified by age, the difference in the CCT between cataract and fellow eyes was greatest in the <1 year age group, but was not statistically significant (P = 0.236). The mean preoperative corneal diameter of operative eyes was 11.0 mm (range, 5.5-12.5 mm [n = 68]). The mean preoperative IOP was 15.1 mm Hg (n = 66). CONCLUSIONS In our study cohort, there was no significant difference in mean preoperative CCT between unilateral pediatric cataract eyes and unaffected fellow eyes.
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Affiliation(s)
- Katherine S Wood
- Medical University of South Carolina, Charleston, South Carolina
| | - Emily Ye
- Medical University of South Carolina, Charleston, South Carolina
| | - Rupal H Trivedi
- Medical University of South Carolina, Charleston, South Carolina
| | - M Edward Wilson
- Medical University of South Carolina, Charleston, South Carolina.
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Hansen MM, Bach-Holm D, Kessel L. Biometry and corneal aberrations after cataract surgery in childhood. Clin Exp Ophthalmol 2022; 50:590-597. [PMID: 35524701 PMCID: PMC9546075 DOI: 10.1111/ceo.14092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 01/20/2023]
Abstract
Background To report long‐term biometric and refractive outcomes in a group of Danish children after surgery for childhood cataract. Methods Children between 7 and 18 years who had undergone uni‐ or bilateral cataract surgery at the Department of Ophthalmology, Rigshospitalet, Denmark, were examined in this cross‐sectional study. Swept source optical coherence tomography (OCT) based optical biometry (IOLmaster 700) and anterior tomography (Pentacam) was performed. Healthy fellow eyes from those with unilateral cataract were used as controls. Results We included 56 children in the study with a median age at surgery of 43.8 months (1.6–137.6). The amount of higher order aberrations was significantly increased in operated eyes (median root mean square 0.461 μm [range 0.264–1.484]) compared with non‐operated eyes (median root mean square 0.337 μm [range 0.162–0.498], p < 0.001). Younger age at surgery was positively associated with more higher order aberrations at follow‐up (p < 0.001), but we found no significant associations between the amount of higher order aberrations and visual acuity or contrast vision. Longer axial length was associated to glaucoma while shorter axial length was associated to strabismus (p < 0.001). Conclusions Eyes operated for childhood cataract have higher order aberrations compared with non‐operated eyes. Higher order aberrations are complex refractive errors that cannot be corrected by normal lenses and may contribute to poor visual outcomes for the children. We found an association between young age at surgery and higher order aberrations.
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Affiliation(s)
- Mathias Møller Hansen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Daniella Bach-Holm
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Chattannavar G, Badakere A, Mohamed A, Kekunnaya R. Visual outcomes and complications in infantile cataract surgery: a real - world scenario. BMJ Open Ophthalmol 2022; 7:e000744. [PMID: 35342821 PMCID: PMC8905877 DOI: 10.1136/bmjophth-2021-000744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/04/2022] [Indexed: 11/11/2022] Open
Abstract
Objective To evaluate visual outcomes and complications of infantile cataract surgery through a 1-year follow-up period in a real world scenario. Methods and analysis Prospective observational study evaluating infants with cataract undergoing surgery. Results We analysed 173 eyes of 97 infants (76 bilateral); median age 18.7 weeks, (IQR: 11–33.9 weeks). Toxoplasmosis, rubella, cytomegalovirus and herpes infection was the most common aetiology in both unilateral 10 (47.6%) and bilateral 43 (55.1%) cases, followed by familial and syndromic cases. Fifty-four eyes (29.5%) received primary intraocular lens (IOL) implantation. Seventy-five infants (76%) were less than 6 months of age. At 1-year follow-up, mean log MAR best-corrected visual acuity was 1.00±0.08 and 1.21±0.03 in unilateral and bilateral cases respectively (p=0.012), which was not statistically significant. At 1-year follow-up, pseudophakic(1.09±0.05) eyes had a better mean log MAR visual acuity comparing aphakes(1.24±0.04) clinically but was not statistically significant after the application of Bonferroni correction (p=0.012). The mean myopic shift of −2.9 D±0.39 and −4.53 D±0.55 over 1 year was noted in aphakes and pseudophakes, respectively (p=0.016). Visual axis opacification and glaucoma were the most common complications noted in pseudophakes and aphakes, respectively. Conclusion Primary IOL implantation in selected cases of infantile cataract is a feasible option, particularly in cases when optimal aftercare and refractive rehabilitation of aphakia are not possible.
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Affiliation(s)
- Goura Chattannavar
- Strabimsus, Pediatric and Neuro-ophthalmology, Jasti V Ramanamma Children's Eye care, Child Sight Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Akshay Badakere
- Strabimsus, Pediatric and Neuro-ophthalmology, Jasti V Ramanamma Children's Eye care, Child Sight Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ramesh Kekunnaya
- Strabimsus, Pediatric and Neuro-ophthalmology, Jasti V Ramanamma Children's Eye care, Child Sight Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Changes in Intraocular Pressure and Anterior Chamber Angle After Congenital Cataract Extraction. J Glaucoma 2021; 30:61-64. [PMID: 32969922 DOI: 10.1097/ijg.0000000000001681] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 09/03/2020] [Indexed: 12/27/2022]
Abstract
PRECIS Anterior chamber angle (ACA) narrowing continues to occur for at least 2 years after congenital cataract surgery. Risk factors for intraocular pressure (IOP) elevation after congenital cataract surgery were higher central corneal thickness (CCT) and surgery at <2 months. PURPOSE The purpose of this study was to study the changes in IOP and in the ACA during the first 2 years after pediatric cataract surgery and to determine risk factors for such changes. PATIENTS AND METHODS A retrospective observational study was done on infants who underwent pediatric cataract surgery in Cairo University Hospitals and completed a 1-year follow-up. Demographic and clinical characteristics were recorded including age at surgery, sex, corneal diameter, CCT pupil diameter, IOP, gonioscopic findings, presence of persistent hyperplastic primary vitreous, surgical approach, primary intraocular lens implantation, and perioperative subconjunctival steroid injection. Changes in IOP and in the ACA were recorded, and the risk factors for such changes were analyzed. RESULTS Postoperative IOP elevation >18 mm Hg occurred in 23 eyes of 206 eyes (11%), who completed Year 1 and in 9 (13%) of 86 eyes who completed Year 2. Risk factors for IOP elevation were larger preoperative CCT (P=0.01) in Year 1, and younger age at surgery (P=0.01), and aphakia (P=0.05) in Year 2. In multivariate analysis only younger age at surgery was a risk factor for IOP elevation in Year 2. ACA narrowing occurred in 49% and in 21% of the examined eyes in Years 1 and 2, respectively. Aphakia was not a significant risk factor of angle narrowing in Years 1 and 2 (P=0.17 and 0.42, respectively). CONCLUSIONS Higher preoperative CCT was a risk factor for early-onset IOP elevation. Surgery at >2 months was associated with lower susceptibility to late-onset IOP elevation.
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Visual acuity, refractive error, and regression outcomes in 169 children with high myopia who were implanted with Ophtec-Artisan or Visian phakic IOLs. J AAPOS 2021; 25:27.e1-27.e8. [PMID: 33621682 DOI: 10.1016/j.jaapos.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze outcomes in a large cohort of spectacle-aversive children with high myopia who were treated by implantation of the Ophtec-Artisan or Visian phakic intraocular lens (pIOL). METHODS Outcome data were collated retrospectively in 78 children (115 eyes) implanted with the Ophtec-Artisan iris-enclaved anterior chamber pIOL and 91 children (154 eyes) implanted with the Visian ICL (intraocular collamer lens) sulcus pIOL. All children had difficulties with spectacle or contact lens wear. Mean age at surgery was 9.9 years; mean follow-up was 3.9 years (range, 0.6-14.1 years). RESULTS A total of 248 of 269 eyes (92%) were corrected to within ± 0.5 D of their target value. Spherical correction averaged 12.3 ± 1.0 D. Refractive spherical regression was -0.04 D/year at last follow-up. Uncorrected distance visual acuity improved from an average logMAR 1.8 to 0.4; corrected distance visual acuity improved an average 0.3 logMAR. Of the treated children, 68% had a gain in binocular fusion. Neurobehavioral and/or visuomotor comorbidities were present in 87% of children. Five eyes (2%) developed retinal detachment an average 6 years after implantation. Nine eyes (3%) implanted with the Ophtec-Artisan pIOL required repositioning after trauma. CONCLUSIONS Implantation of pIOLs in children is an effective method for correcting high myopia in spectacle noncompliant children. Rates of myopic regression after pIOL surgery are substantially lower than those reported for children treated by excimer laser photorefractive keratectomy (PRK). The prevalence of major complications was relatively low in this high-risk population.
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Maripudi S, Byrd J, Qureshi A, Stoleru G, Levin MR, Saeedi OJ, Munir W, Bazemore M, Karwoski B, Martinez C, Jaafar MS, Madigan WP, Alexander JL. Pediatric Corneal Structural Development During Childhood Characterized by Ultrasound Biomicroscopy. J Pediatr Ophthalmol Strabismus 2020; 57:238-245. [PMID: 32687208 PMCID: PMC7907682 DOI: 10.3928/01913913-20200506-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/14/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To quantitatively describe the structural corneal changes from infancy to early adulthood using ultrasound biomicroscopy. METHODS In this prospective study, 168 ultrasound biomicroscopy images were obtained from 24 healthy eyes of 24 patients who consented and enrolled in the Pediatric Anterior Segment Imaging Innovation Study. Their ages ranged from birth to 26 years. An established ultrasound biomicroscopy imaging protocol including seven views of one eye per patient were obtained and measured using ImageJ software (National Institutes of Health). Twelve corneal structural parameters were measured. Means were compared between younger and older groups. RESULTS Among the 12 measured structures, 5 demonstrated statistically significant differences (P < .05) between patients younger than 1 year and patients older than 1 year. The mean values for corneal cross-sectional width and length, central corneal thickness, and radii of curvature (anterior and posterior) were significantly different in patients younger than 1 year. Curvature and limbus-to-limbus dimensions changed more dramatically than thickness and tissue density. When comparing the youngest to oldest subgroups, anterior curvature flattened (6.14 to 7.55 radius), posterior curvature flattened (5.53 to 6.72 radius), angle-to-angle distance increased (8.93 to 11.40 mm), and endothelial cross-sectional distance increased (10.63 to 13.61 mm). CONCLUSIONS Pediatric corneal structures change with age. The most significant changes occur in the first months of life, with additional changes later in childhood. This study further demonstrates the importance of age in pediatric corneal imaging analysis. [J Pediatr Ophthalmol Strabismus. 2020;57(4):238-245.].
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Abstract
PURPOSE To study the central corneal thickness (CCT) in eyes with microcornea and aphakia and without glaucoma, compare it with normal controls, and correlate it with the measured intraocular pressure (IOP). METHODS The study was conducted on 62 eyes of 31 aphakic children with microcornea. Controls (20 children) were selected from age-matched children presenting for routine refraction. Detailed anterior-segment and fundus examinations were conducted. The CCT and the axial length were measured. Medical records of the study patients were reviewed for the stability of the ocular parameters over time to exclude glaucoma. RESULTS The mean±SD age of the study patients and controls were 4.0 (±3.1, 1.0 to 12.0) and 3.1 (±2.7, 0.6 to 12.0) years, respectively. The mean±SD CCT, the corneal diameter, the measured IOP, the cup/disc ratio, and the axial length of the study patients and the controls were 667.01±72.90 μm, 8.9±0.8 mm, 10.9±5.7 mm Hg, 0.1±0.1, 20.35±2.90 mm and 545.22±28.14 μm, 11.7±0.5 mm, 5.3±1.8 mm Hg, 0.1±0.1, and N/A, respectively. The difference between the study eyes and the controls in the CCT and the measured IOP was statistically significant (P<0.05). CONCLUSIONS Aphakic eyes with microcornea have thicker CCTs and greater measured IOPs than normal eyes. Hence, the measurement of CCT is recommended in the assessment of aphakic eyes with microcornea for possible glaucoma. The measured IOP, although a reliable parameter, in isolation does not provide a diagnosis of glaucoma and must be viewed in conjunction with other patient findings, such as the cup/disc ratio, the progression of which over time must be considered for a more solid diagnosis.
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Central corneal thickness and intraocular pressure changes after congenital cataract surgery with intraocular lens implantation in children younger than 2 years. J Cataract Refract Surg 2017; 43:662-666. [DOI: 10.1016/j.jcrs.2017.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/27/2017] [Accepted: 02/05/2017] [Indexed: 11/22/2022]
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Tychsen L, Faron N, Hoekel J. Phakic Intraocular Collamer Lens (Visian ICL) Implantation for Correction of Myopia in Spectacle-Aversive Special Needs Children. Am J Ophthalmol 2017; 175:77-86. [PMID: 27939561 DOI: 10.1016/j.ajo.2016.11.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE A subset of children with high anisometropia or isoametropia and neurobehavioral disorders have chronic difficulties with spectacle or contact lens wear. We report the results of refractive surgery in a series of these children treated using bilateral or unilateral intraocular collamer lens (Visian ICL) implantation for moderate to high myopia. DESIGN Prospective nonrandomized cohort study. METHODS Clinical course and outcome data were collated prospectively for 40 implanted eyes in 23 children (mean age 10.2 ± 5.3 years, range, 1.8-17 years). Myopia ranged from -3.0 to -14.5 diopters (D), mean -9.2 ± 3.5 D. Goal refraction was plano to +1 D. Correction was achieved by sulcus implantation of a Visian ICL (STAAR Surgical, Monrovia, California, USA) under general anesthesia. Mean follow-up was 15.1 months (range, 6-22 months). RESULTS Thirty-five eyes (88%) were corrected to within ±1.0 D of goal refraction; the other 5 (12%) were corrected to within 1.5 D. Uncorrected distance visual acuity improved substantially in all eyes (from mean 20/1050 [logMAR 1.72] to mean 20/42 [logMAR 0.48]). Spherical regression at last follow-up was an average of +0.59 D. Visuomotor comorbidities (eg, amblyopia, nystagmus, foveopathy, optic neuropathy) accounted for residual postoperative subnormal visual acuity. Thirteen of the 23 children (57%) had a neurobehavioral disorder (eg, developmental delay/intellectual disability/mental retardation, Down syndrome, cerebral palsy, autism spectrum disorder). Eighty-five percent (11/13) of those children were reported to have enhanced visual awareness, attentiveness, or social interactions. Endothelial cell density was measureable in 6 cooperative children (10 eyes), showing an average 1% decline. Central corneal thickness, measured in all children, increased an average of 8 μm. Two children (8%) required unplanned return to the operating room on the first postoperative day to alleviate pupillary block caused by a nonpatent iridotomy. No other complications were encounterd. CONCLUSION Visian ICL implantation improves visual function in special needs children who have moderate to high myopia and difficulties wearing glasses or contact lenses.
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Praveen MR, Vasavada AR, Shah SK, Khamar MB, Trivedi RH. Long-term postoperative outcomes after bilateral congenital cataract surgery in eyes with microphthalmos. J Cataract Refract Surg 2016; 41:1910-8. [PMID: 26603400 DOI: 10.1016/j.jcrs.2015.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/31/2015] [Accepted: 02/03/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the long-term impact of bilateral cataract surgery on postoperative complications, influence of age at surgery on the pattern of axial growth and central corneal thickness (CCT), and visual and orthoptic assessment in microphthalmic eyes. SETTING Iladevi Cataract and IOL Research Centre, Ahmedabad, India. DESIGN Prospective longitudinal study. METHODS This study assessed children with microphthalmos who had bilateral congenital cataract surgery. Microphthalmos was defined as an eye that has an axial length (AL) that was 2 standard deviations smaller than what is normally expected at that age. All eyes were left aphakic. One of the 2 eyes was randomly selected for analysis. Postoperative complications, AL, CCT, and visual acuity were documented. RESULTS This study included 72 eys of 36 children. The mean age of the patients was 4.8 months ± 6.2 (SD) (range 0.5 to 15 months). Postoperative complications included secondary glaucoma (11/36, 30.6%), visual axis obscuration (4/36, 11.1%), and posterior synechiae (10/36, 27.8%). A significant rate of change was observed in axial growth up to 4 years and in CCT up to 3 years postoperatively. When age at the time of surgery was correlated with the profile of the rate of change in AL and CCT at 1 month and 1, 2, and 4 years, statistically significant differences in AL and CCT at all timepoints were found. Loss of vision after surgery occurred in 2 eyes. CONCLUSION After early surgical intervention, an acceptable rate of serious postoperative complications and good visual outcomes were obtained in microphthalmic eyes. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Mamidipudi R Praveen
- From the Iladevi Cataract & IOL Research Center (Praveen, Vasavada, Shah), Raghudeep Eye Clinic, Glaucoma Center (Khamar), Iladevi Cataract & IOL Research Center, Raghudeep Eye Clinic, Memnagar, Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Abhay R Vasavada
- From the Iladevi Cataract & IOL Research Center (Praveen, Vasavada, Shah), Raghudeep Eye Clinic, Glaucoma Center (Khamar), Iladevi Cataract & IOL Research Center, Raghudeep Eye Clinic, Memnagar, Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Sajani K Shah
- From the Iladevi Cataract & IOL Research Center (Praveen, Vasavada, Shah), Raghudeep Eye Clinic, Glaucoma Center (Khamar), Iladevi Cataract & IOL Research Center, Raghudeep Eye Clinic, Memnagar, Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mayuri B Khamar
- From the Iladevi Cataract & IOL Research Center (Praveen, Vasavada, Shah), Raghudeep Eye Clinic, Glaucoma Center (Khamar), Iladevi Cataract & IOL Research Center, Raghudeep Eye Clinic, Memnagar, Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rupal H Trivedi
- From the Iladevi Cataract & IOL Research Center (Praveen, Vasavada, Shah), Raghudeep Eye Clinic, Glaucoma Center (Khamar), Iladevi Cataract & IOL Research Center, Raghudeep Eye Clinic, Memnagar, Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
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Morrison DG, Lynn MJ, Freedman SF, Orge FH, Lambert SR. Corneal Changes in Children after Unilateral Cataract Surgery in the Infant Aphakia Treatment Study. Ophthalmology 2015; 122:2186-92. [PMID: 26271843 PMCID: PMC4624013 DOI: 10.1016/j.ophtha.2015.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 12/19/2022] Open
Abstract
PURPOSE We report endothelial cell (EC) characteristics and central corneal thickness (CCT) from the Infant Aphakia Treatment Study (IATS) patients at the 5-year examination. DESIGN Randomized, controlled trial of the treatment of unilateral cataract with aphakic contact lens (CL) versus primary intraocular lens (IOL) implant. PARTICIPANTS A total of 114 infants with unilateral cataract. METHODS The EC density, coefficient of variation (CV), and percent hexagonal cells were measured by noncontact specular microscopy. The CCT was measured using contact pachymetry. Fellow eyes served as controls. MAIN OUTCOME MEASURES Mean differences between treated and fellow eyes of CL and IOL groups were compared with a paired t test. A 1-way analysis of variance model and the Tukey-Kramer multiple comparison procedure were used to assess the effect of a diagnosis of glaucoma or glaucoma suspect. RESULTS A total of 105 subjects (52 with CLs, 53 with IOLs) had specular microscopy or corneal thickness data recorded. Mean EC densities were higher in aphakic eyes compared with fellow eyes (3921 vs. 3495 cells/mm2, P<0.0001). Mean CV was higher (27 vs. 24, P=0.0002) and mean percent hexagonal cells was lower (72% vs. 76%, P=0.002) in aphakic eyes compared with fellow eyes. Mean CCT of aphakic eyes was higher than in controls (637 vs. 563 μm, P<0.0001). There was no difference in EC density in eyes treated with IOLs compared with fellow eyes (3445 and 3487 cells/mm2, P=0.68). Means for CV (25 vs. 24, P=0.07) and percent hexagonal cells (74 vs. 76%, P=0.27) were also not significantly different. Mean CCT was higher in eyes with IOLs (605 vs. 571 μm, P<0.0001) compared with fellow eyes. Compared with treated eyes without glaucoma or glaucoma suspect, treated eyes with glaucoma had lower EC density (3289 vs. 3783 cells/mm2, P=0.03) and treated eyes with glaucoma suspect had greater mean corneal thickness (660 vs. 612 μm, P=0.0036). CONCLUSIONS Cataract extraction during infancy with IOL implantation was not associated with a reduced EC count in treated compared with fellow eyes, although CCT was increased. Extended-wear aphakic CLs may cause corneal polymegathism with increased EC density and CCT. Glaucoma diagnosis was associated with reduced EC counts and increased CCT.
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Affiliation(s)
- David G Morrison
- Department of Ophthalmology and Visual Sciences, Vanderbilt University, Nashville, Tennessee.
| | - Michael J Lynn
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
| | - Faruk H Orge
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Scott R Lambert
- Department of Ophthalmology, Emory University, Atlanta, Georgia
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Ventura MC, Ventura BV, Ventura CV, Ventura LO, Arantes TE, Nosé W. Outcomes of congenital cataract surgery: intraoperative intracameral triamcinolone injection versus postoperative oral prednisolone. J Cataract Refract Surg 2014; 40:601-8. [PMID: 24530023 DOI: 10.1016/j.jcrs.2013.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/02/2013] [Accepted: 09/08/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the outcomes of congenital cataract surgery using intraoperative intracameral triamcinolone versus postoperative oral prednisolone to modulate ocular inflammation. SETTING Department of Congenital Cataract, Altino Ventura Foundation, Recife, Brazil. DESIGN Randomized clinical trial. METHODS Children younger than 2 years were randomly divided into 2 groups. The study group received an intraoperative intracameral injection of 1.2 mg/0.03 mL of triamcinolone acetonide. The control group (29 eyes) received 1 mg/kg per day of prednisolone syrup for 15 days postoperatively, which was then tapered over the following 2 weeks. Intraocular pressure (IOP), central corneal thickness (CCT), cell deposits on the intraocular lens (IOL), posterior synechiae, visual axis obscuration, additional surgical procedures, and IOL centration were assessed 12 months postoperatively. RESULTS The mean patient age at surgery was 10.45 months±6.22 (SD) in the study group (31 eyes) and 10.0±6.15 months in the control group (29 eyes) (P=.779). In both groups, the mean IOP and CCT did not change significantly postoperatively (study group P=.922 and P=.149, respectively; control group P=.483 and P=.416, respectively). The groups had similar incidences of cell deposits (P=.517) and posterior synechiae (P=.247). No eye developed visual axis obscuration or had additional surgical procedures. All eyes had a clinically centered IOL. CONCLUSION One year postoperatively, the outcomes were similar with intraoperative intracameral triamcinolone injection and postoperative oral prednisolone for modulating inflammation after congenital cataract surgery. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Marcelo C Ventura
- From the Department of Congenital Cataract (M.C. Ventura, B.V. Ventura, C.V. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Altino Ventura Foundation, and the Department of Congenital Cataract (M.C. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Pernambuco Eye Hospital, Recife; the Department of Ophthalmology (Nosé), Federal University of São Paulo, São Paulo, Brazil.
| | - Bruna V Ventura
- From the Department of Congenital Cataract (M.C. Ventura, B.V. Ventura, C.V. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Altino Ventura Foundation, and the Department of Congenital Cataract (M.C. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Pernambuco Eye Hospital, Recife; the Department of Ophthalmology (Nosé), Federal University of São Paulo, São Paulo, Brazil
| | - Camila V Ventura
- From the Department of Congenital Cataract (M.C. Ventura, B.V. Ventura, C.V. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Altino Ventura Foundation, and the Department of Congenital Cataract (M.C. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Pernambuco Eye Hospital, Recife; the Department of Ophthalmology (Nosé), Federal University of São Paulo, São Paulo, Brazil
| | - Liana O Ventura
- From the Department of Congenital Cataract (M.C. Ventura, B.V. Ventura, C.V. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Altino Ventura Foundation, and the Department of Congenital Cataract (M.C. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Pernambuco Eye Hospital, Recife; the Department of Ophthalmology (Nosé), Federal University of São Paulo, São Paulo, Brazil
| | - Tiago E Arantes
- From the Department of Congenital Cataract (M.C. Ventura, B.V. Ventura, C.V. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Altino Ventura Foundation, and the Department of Congenital Cataract (M.C. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Pernambuco Eye Hospital, Recife; the Department of Ophthalmology (Nosé), Federal University of São Paulo, São Paulo, Brazil
| | - Walton Nosé
- From the Department of Congenital Cataract (M.C. Ventura, B.V. Ventura, C.V. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Altino Ventura Foundation, and the Department of Congenital Cataract (M.C. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Pernambuco Eye Hospital, Recife; the Department of Ophthalmology (Nosé), Federal University of São Paulo, São Paulo, Brazil
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Lambert SR, Purohit A, Superak HM, Lynn MJ, Beck AD. Long-term risk of glaucoma after congenital cataract surgery. Am J Ophthalmol 2013; 156:355-361.e2. [PMID: 23639132 PMCID: PMC3720778 DOI: 10.1016/j.ajo.2013.03.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/11/2013] [Accepted: 03/12/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the long-term risk of glaucoma development in children following congenital cataract surgery. DESIGN Retrospective interventional consecutive case series. METHODS We retrospectively reviewed the records of 62 eyes of 37 children who underwent congenital cataract surgery when <7 months of age by the same surgeon using a limbal approach. The Kaplan-Meier method was used to calculate the probability of an eye's developing glaucoma and/or becoming a glaucoma suspect over time. RESULTS The median age of surgery was 2.0 months and the median follow-up after cataract surgery was 7.9 years (range, 3.2-23.5 years). Nine eyes (14.5%) developed glaucoma a median of 4.3 months after cataract surgery and an additional 16 eyes (25.8%) were diagnosed as glaucoma suspects a median of 8.0 years after cataract surgery. The probability of an eye's developing glaucoma was estimated to be 19.5% (95% CI: 10.0%-36.1%) by 10 years after congenital cataract surgery. When the probability of glaucoma and glaucoma suspect were combined, the risk increased to 63.0% (95% CI: 43.6%-82.3%). CONCLUSIONS Long-term monitoring of eyes after congenital cataract surgery is important because we estimate that nearly two thirds of these eyes will develop glaucoma or become glaucoma suspects by 10 years after cataract surgery.
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Affiliation(s)
- Scott R Lambert
- Department of Ophthalmology, Emory University, Atlanta, GA 30322, USA.
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Ruddle JB, Staffieri SE, Crowston JG, Sherwin JC, Mackey DA. Incidence and predictors of glaucoma following surgery for congenital cataract in the first year of life in Victoria, Australia. Clin Exp Ophthalmol 2013; 41:653-61. [PMID: 23332011 DOI: 10.1111/ceo.12067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
Abstract
AIM To determine the incidence and predictors of glaucoma following surgery for congenital and infantile cataract in an Australian population. DESIGN Retrospective cohort study. PARTICIPANTS Infants (<12 months) having had lens extraction between January 1992 and May 2006, from two tertiary referral centres. METHODS Children with uveitis, anterior segment dysgenesis, aniridia, retinopathy of prematurity, and lens subluxation were excluded. Potential predictors of incident glaucoma were examined using Cox proportional hazards regression with adjustment for clustering between eyes. MAIN OUTCOME MEASURES Incidence and predictors of secondary glaucoma. RESULTS One hundred and forty-seven eyes of 101 patients (46 bilateral cataract; 55 unilateral cataract) were included, with median follow-up of 9.9 years (range 1.2-18.9 years). Cumulative incidence of glaucoma was 32.0% for eyes (n = 47) and 30.7% (n = 31) for subjects. Incidence was higher in children with bilateral cataract (38.9 vs. 17.1%, p = 0.004). There were 3.9 cases of glaucoma per 100 person years of follow-up, the incidence rate being highest for surgery performed in the first month of life. Children with glaucoma had longer median follow-up (11.8 vs. 9.3 years, p = 0.005). Risk of glaucoma decreased with increasing months of age at operation: hazard ratio 0.79, 95% confidence interval 0.69-0.91, p = 0.001. Median visual acuity was worse in children with unilateral cataract (p < 0.001). CONCLUSIONS We identified an increased risk of glaucoma when cataract surgery was performed in younger infants, and in those with bilateral cataract. As glaucoma may develop over a decade following lens extraction, life-long surveillance is needed to prevent glaucoma-associated vision loss.
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Affiliation(s)
- Jonathan B Ruddle
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
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Advances in the management of the surgical complications for congenital cataract. Front Med 2012; 6:360-5. [PMID: 23224414 DOI: 10.1007/s11684-012-0235-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022]
Abstract
The greatest concern in children with cataracts is irreversible visual loss. The timing of congenital cataract surgery is critical for the visual rehabilitation. Cataract surgery in children remains complex and challenging. The incidence of complications during or after operation is higher in children than adults. Some complications could be avoided by meticulous attention to surgical technique and postoperative care, and others were caused by more exuberant inflammatory response associated with surgery on an immature eye or the intrinsic eyes abnormalities. Utilizing of advanced techniques and timely applying topical corticosteroids and cycloplegic agents can reduce the occurrence of visual axis opacification. Operation on children with strabismus or nystagmus, and applying occlusion therapy on amblyopic eyes can balance the visual inputs to the two eyes. Diagnosis of glaucoma following congenital cataract surgery requires lifelong surveillance and continuous assessment of the problem. So cataract surgeries in children are not the end of journey, but one step on the long road to visual rehabilitation. This paper describes recent evidence from the literature regarding the advance of management after congenital cataract surgery.
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Ventura MC, Ventura BV, Ventura CV, Ventura LO, Nosé W. Congenital cataract surgery with intracameral triamcinolone: pre- and postoperative central corneal thickness and intraocular pressure. J AAPOS 2012; 16:441-4. [PMID: 23084381 DOI: 10.1016/j.jaapos.2012.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 06/10/2012] [Accepted: 06/18/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the change in intraocular pressure (IOP) and central corneal thickness (CCT) of children who underwent congenital cataract surgery with injection of triamcinolone acetonide into the anterior chamber at the end of the procedure. METHODS Fifty-three eyes of 34 children <2 years of age who underwent congenital cataract surgery with injection of 1.2 mg/0.03 mL of preservative-free triamcinolone acetonide into the anterior chamber at the end of the procedure were included in this study. IOP and CCT were measured preoperatively and at a mean of 2 and 12 months' follow-up. RESULTS The mean IOP was 8.7 ± 0.4 mm Hg preoperatively, 8.4 ± 0.6 mm Hg at the 2-month follow-up, and 8.1 ± 0.3 mm Hg at the 12-month follow-up. The mean CCT was 562 ± 11 μm preoperatively, 563 ± 10 μm at the 2-month follow-up, and 570 ± 10 μm at the 12-month follow-up. There was no significant change in either pre- or postoperative IOP (P = 0.700) or CCT (P = 0.419) over the study period. CONCLUSIONS Injection of 1.2 mg triamcinolone acetonide at the end of congenital cataract surgery in children <2 years of age did not significantly affect IOP or CCT in the first year after surgery.
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Edward D. A potpourri of ocular disorders. Middle East Afr J Ophthalmol 2012; 19:177. [PMID: 22623854 PMCID: PMC3353663 DOI: 10.4103/0974-9233.95244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Beck AD, Freedman SF, Lynn MJ, Bothun E, Neely DE, Lambert SR. Glaucoma-related adverse events in the Infant Aphakia Treatment Study: 1-year results. ACTA ACUST UNITED AC 2011; 130:300-5. [PMID: 22084157 DOI: 10.1001/archophthalmol.2011.347] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To report the incidence of glaucoma and glaucoma suspects in the IATS, and to evaluate risk factors for the development of a glaucoma-related adverse event in patients in the IATS in the first year of follow-up. METHODS A total of 114 infants between 1 and 6 months of age with a unilateral congenital cataract were assigned to undergo cataract surgery either with or without an intraocular lens implant. Standardized definitions of glaucoma and glaucoma suspect were created and used in the IATS. RESULTS Of these 114 patients, 10 (9%) developed glaucoma and 4 (4%) had glaucoma suspect, for a total of 14 patients (12%) with a glaucoma-related adverse event in the treated eye through the first year of follow-up. Of the 57 patients who underwent lensectomy and anterior vitrectomy, 5 (9%) developed a glaucoma-related adverse event; of the 57 patients who underwent an intraocular lens implant, 9 (16%) developed a glaucoma-related adverse event. The odds of developing a glaucoma-related adverse event were 3.1 times higher for a child with persistent fetal vasculature and 1.6 times higher for each month of age younger at cataract surgery. CONCLUSIONS Modern surgical techniques do not eliminate the early development of glaucoma following congenital cataract surgery with or without an intraocular lens implant. Younger patients with or without persistent fetal vasculature seem more likely to develop a glaucoma-related adverse event in the first year of follow-up. Vigilance for the early development of glaucoma is needed following congenital cataract surgery, especially when surgery is performed during early infancy or for a child with persistent fetal vasculature. Five-year follow-up data for the IATS will likely reveal more glaucoma-related adverse events. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00212134.
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