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Yehezkeli V, Hare I, Moisseiev E, Assia EI, Chacham I, Ela-Dalman N. Assessment of long-term visual outcomes in aphakic children wearing scleral contact lenses. Eye (Lond) 2023; 37:421-426. [PMID: 35102246 PMCID: PMC9905087 DOI: 10.1038/s41433-022-01942-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 12/17/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Timely management of aphakic children is critical for the rehabilitation of adequate visual gain. This study aims to evaluate the long-term efficacy of scleral contact lenses in terms of visual outcomes, complications, and compliance in aphakic children. METHODS Retrospective data review of children with congenital or acquired cataract, or subluxated crystalline lenses, who underwent lensectomy from 2004 to 2018 and who used scleral contact lenses for refractive correction. Collected data from the follow up period included recorded aphakic refraction and visual acuity, complications following scleral contact lens wear documented in the clinic and ophthalmic emergency room and compliance to lens wear according to parental feedback on every visit in the clinic. RESULTS 76% of cases, with final best corrected visual acuity (BCVA) of 20/40 or better achieved in seventeen eyes (34%). The rate of amblyopia was 50%. Strabismus developed in 56% of children, and those had less favourable visual outcomes (0.43 ± 0.4 LogMAR without strabismus and 0.8 ± 0.5 LogMAR with strabismus, p = 0.015). No corneal infections were documented during the follow up. Main adverse effect on the ocular surface was superficial punctate keratopathy (n = 16). Compliance was good in 48 children (96%)- except for two cases, the scleral lenses were tolerated well by all children. CONCLUSION Scleral contact lenses are an effective means of visual rehabilitation in aphakic children after lensectomy and may be used long-term with good compliance of wear, excellent visual outcomes, and tolerable adverse events.
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Affiliation(s)
| | - Ivan Hare
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Optometric Clinic, Raanana, Israel
| | - Elad Moisseiev
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud I Assia
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Noa Ela-Dalman
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kooshki AM, Kooshki AM, Yaseri M, Nouri L, Alipour F. Experiences of Treatment With Contact Lenses in Aphakic Children With Unilateral Congenital Cataract: A Retrospective Study. Eye Contact Lens 2022; 48:222-227. [PMID: 35333798 DOI: 10.1097/icl.0000000000000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Congenital cataract is a condition compromising the eye's crystalline lens in infants and is usually diagnosed at birth. It can lead to irreversible vision loss if not promptly detected and treated, especially in unilateral cases. Nowadays, children with congenital cataracts can undergo surgical removal of their opacified crystalline lenses, and visual rehabilitation is mandatory to prevent deep amblyopia. Contact lenses, predominantly of rigid gas-permeable (GP) type, are gaining more popularity for this matter. METHOD In this retrospective cohort study, unilateral aphakic children younger than 6 years referred to the Contact Lens Clinic at Farabi Eye Hospital from November 2011 to September 2019 were included. RESULTS Seventy-six unilateral aphakic children with congenital cataracts (57.9% boys and 42.1% girls) rehabilitated with GP were studied. The mean age of diagnosis and referral to the contact lens clinic were 20.0±19.8 and 32.0±24.4 weeks, respectively, while the mean follow-up time was 12.44±26.28 months. The mean visual acuity for children capable of cooperating at the last follow-up was 0.98±0.62 log MAR. Among the participants, eight children (9.7%) were diagnosed as glaucoma suspects. The mean initial base curve and power of GP lenses were 7.86±0.39 mm and 23.29±5.52 diopters, respectively. Only 21 parents (27.6%) reported nonadherence to the scheduled part-time patch program. CONCLUSION The results of this study showed GP-based optical treatment after early diagnosis, surgical removal of congenital cataracts, and a long-term close follow-up to be well tolerated by children and their parents, with acceptable parents' compliance and can thus be introduced as a safe and effective method to achieve desirable visual outcomes.
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Affiliation(s)
- Abdolreza M Kooshki
- Department of ophthalmology (A.M.K., A.M.K., L.N.), Eye Research Center, Farabi Eye Hospital Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics (M.Y.), School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Department of ophthalmology (F.A.), Eye Research Center, Farabi Eye, Tehran, Iran
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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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Zhao QH, Zhao YE. Commentary review: challenges of intraocular lens implantation for congenital cataract infants. Int J Ophthalmol 2021; 14:923-930. [PMID: 34150549 DOI: 10.18240/ijo.2021.06.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/14/2021] [Indexed: 11/23/2022] Open
Abstract
As an indispensable part of congenital cataract surgery, intraocular lens (IOL) implantation in infantile patients has long-term positive impacts on visual rehabilitation, as well as postoperative complications inevitably. Timing of IOL implantation in infantile congenital cataract patients is not simply a point-in-time but a personalized decision that comprehensively takes age at surgery, risks of postoperative complications, and economic condition of family in consideration, and combines with choosing suitable IOL type and power. For infants with well-developed eyeballs and good systemic conditions, IOL implantation at six months of age or older is safe and effective. Otherwise, secondary IOL implantation may be a safer choice.
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Affiliation(s)
- Qi-Hui Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yun-E Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
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Eppley SE, Arnold BF, Tadros D, Pasricha N, de Alba Campomanes AG. Accuracy of a universal theoretical formula for power calculation in pediatric intraocular lens implantation. J Cataract Refract Surg 2021; 47:599-605. [PMID: 33181623 DOI: 10.1097/j.jcrs.0000000000000495] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the accuracy of Barrett Universal II formula with other formulas (Holladay 2, Hoffer Q, and SRK/T formulas) in the prediction of postoperative refraction for pediatric intraocular lens implantation. SETTING Academic medical center/children's hospital, San Francisco, California. DESIGN Retrospective case series. METHODS Children aged 16 years or younger who underwent cataract extraction and IOL implantation (2012 to 2019) and had refraction assessed at 3 to 16 weeks postoperatively were included. Prediction error (PE) was calculated as postoperative mean spherical equivalent minus the target refraction. Mean, median, and standard deviation was calculated for PE and absolute PE. Performance across covariables (axial length, age, biometry type, keratometry, etc.) was studied, and a multivariate regression analysis was performed using a single prediction model for each formula. RESULTS Sixty-four eyes of 64 patients, aged 1.5 to 15.5 years, were included. Barrett Universal II formula had the lowest mean PE (-0.22 diopters [D]), SD (1.18 D), median PE (-0.26 D), and median absolute PE (0.71) compared with those of the other formulas. Holladay 2 formula performed similarly to Barrett Universal II formula, and SRK/T formula had the greatest mean PE (-0.50 D) and SD (1.22 D). Barrett Universal II formula predictions were stable across all variables. CONCLUSIONS Barrett Universal II formula demonstrated similar or superior performance when compared with other formulas in this pediatric study. Holladay 2 formula performed similarly to Barrett Universal II formula, and SRK/T formula had the least reliable performance, across several key biometric characteristics. Although PEs can be highly variable in pediatric populations, this study supports Barrett Universal II formula as a reasonable and reliable option for lens power calculation in children, including those with extreme biometric measurements.
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Affiliation(s)
- Sarah E Eppley
- From the School of Medicine, University of California, San Francisco (Eppley and Campomanes); Francis I. Proctor Foundation, University of California, San Francisco (Arnold); Department of Ophthalmology, Faculty of Medicine, Tanta University, Egypt (Tadros); and Department of Ophthalmology, University of California, San Francisco (Arnold, Pasricha, and de Alba Campomanes)
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Chen H, Lin Z, Chen J, Li X, Zhao L, Chen W, Lin H. The impact of an interactive, multifaceted education approach for congenital cataract on parental anxiety, knowledge and satisfaction: A randomized, controlled trial. PATIENT EDUCATION AND COUNSELING 2020; 103:321-327. [PMID: 31522896 DOI: 10.1016/j.pec.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of our research was to examine the impact of a patient education program for parents of children with congenital cataract on parental stress, comprehension of disease information and parental satisfaction. METHODS This prospective study included 177 parents of children with congenital cataract. The children were randomized into the following groups: the health education program with a multifaceted, interactive approach and conventional follow-up. Self-administered questionnaires were used for parental evaluation before and after the education program. The anxiety level, parental satisfaction and comprehension of the information were evaluated at each time point. RESULTS A multifaceted, interactive approach to education significantly reduced parental levels of anxiety compared with the conventional group (effect sizes: Parenting Stress Index, ƞ2 = 0.285; Ocular Treatment Index, ƞ2 = 0.346). This approach also improved comprehension-memorization scores (effect sizes: ƞ2 = 0.303) and parental satisfaction (p < 0.001). The impact of this new intervention was maintained for 6 and 12 months after the course. CONCLUSION The interactive, multifaceted education approach could efficiently improve the comprehension of disease-related information and parental satisfaction, resulting in significantly decreased parental anxiety. PRACTICE IMPLICATIONS This new patient education approach had a significant impact on congenital cataracts and may be generalized to other pediatric diseases.
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Affiliation(s)
- Hui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhuoling Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jingjing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Kang S, Park E, Seo K. A new treatment for presumed corneal epithelial inclusion cyst in a shih-tzu dog. J Small Anim Pract 2019; 61:776-781. [PMID: 31016746 DOI: 10.1111/jsap.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/22/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
An 8-year-old female shih-tzu was assessed for a 3-year history of yellow intrastromal material in the right eye. Slit-lamp biomicroscopy showed a yellow lesion in the upper half of the cornea, superficial corneal neovascularisation and oedema with negative fluorescein staining in the right eye. Ultrasound biomicroscopy revealed a nearly anechoic cystic space surrounded by hyperechoic oedematous cornea separating the stroma at three-quarters of the corneal depth. Two partial-thickness corneal incisions were performed around the lesion under topical anaesthesia. After cytology and culture sampling, intrastromal flushing was performed. A yellow viscous necrotic tissue was identified with no microorganism or evidence of tumour formation. Antibiotics, anti-inflammatories and a bandage contact lens were applied. Ultrasound biomicroscopy confirmed no recurrence 8 days later. Corneal neovascularisation and oedema gradually resolved through a 2-week follow-up. There was no recurrence in the subsequent 8 months.
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Affiliation(s)
- S Kang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Republic of Korea
| | - E Park
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Republic of Korea
| | - K Seo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Republic of Korea
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Jinagal J, Gupta G, Agarwal A, Aggarwal K, Akella M, Gupta V, Suri D, Gupta A, Singh S, Ram J. Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis. Indian J Ophthalmol 2019; 67:69-74. [PMID: 30574896 PMCID: PMC6324120 DOI: 10.4103/ijo.ijo_713_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of intraoperative intravitreal dexamethasone implant in patients of juvenile idiopathic arthritis (JIA)-associated uveitis undergoing phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation. METHODS Retrospectively, data of patients with JIA-associated uveitis undergoing phacoemulsification with PCIOL implantation with intraoperative dexamethasone implant injection were analyzed. Patients with a minimum follow-up of 6 months were included. Primary outcome measures were ocular inflammation, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and worsening of uveitis. RESULTS 8 eyes of 6 patients were included. BCVA was significantly improved at 1, 3, and 6 months postoperatively 0.20 ± 0.09, P = 0.008; 0.18 ± 0.11, P = 0.008; and 0.24 ± 0.11, P = 0.01, respectively. No statistical difference noted in mean IOP at various follow-up visits. None developed worsening of uveitis or Cystoid macular edema. CONCLUSION Intraoperative intravitreal dexamethasone implant is a safe and effective in preventing and managing the postoperative inflammation in children with JIA-associated uveitic cataract.
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Affiliation(s)
- Jitender Jinagal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Gaurav Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Madhuri Akella
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Deepti Suri
- Department of Pediatrics, Division of Allergy and Immunology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Anju Gupta
- Department of Pediatrics, Division of Allergy and Immunology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Surjit Singh
- Department of Pediatrics, Division of Allergy and Immunology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Abstract
OBJECTIVES Surveys are an important tool to assess the impact of research on physicians' approach to patient care. This survey was conducted to assess current practice patterns in the management of infantile cataracts in light of the findings of the Infant Aphakia Treatment Study. METHODS Pediatric ophthalmologists were emailed a link to the survey using newsletters from American Association of Pediatric Ophthalmology and Strabismus, World Society of Pediatric Ophthalmology and Strabismus, and the Pediatric Listserv. The 17-question survey was anonymous and active during July to August 2016. RESULTS One hundred twenty-five respondents (North America, 65%; Asia, 12%; Europe, 9%; and other, 14%) reported operating on pediatric cataracts. Most practice in a university setting (55%). There was a strong consensus that unilateral cataract surgery should be performed between ages 4 to 6 weeks and aphakic contact lenses should be used to optically correct their eyes, particularly in children ≤6 months of age. For bilateral cataracts, there was a trend for surgeons to perform cataract surgery at an older age than unilateral cataract surgery. Surgeons who performed less than 5 versus greater than 20 pediatric cataract surgeries/year were more likely to use aphakic contact lenses in children undergoing cataract surgery more than 6 months of age (62% vs. 35%, P=0.04). Most respondents (73%) indicated that the Infant Aphakia Treatment Study had changed how they manage unilateral congenital cataracts. CONCLUSION Most pediatric cataract surgeons perform congenital cataract surgery between ages 4 to 6 weeks and use aphakic contact lenses for initial optical correction in infants less than 6 months. Surgeons have equal preference for intraocular lenses and contact lenses in infants more than 6 months of age.
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Effect of Timing of Initial Cataract Surgery, Compliance to Amblyopia Therapy on Outcomes of Secondary Intraocular Lens Implantation in Chinese Children: A Retrospective Case Series. J Ophthalmol 2018; 2018:2909024. [PMID: 29765779 PMCID: PMC5885399 DOI: 10.1155/2018/2909024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/19/2018] [Accepted: 02/06/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose As a secondary analysis, we reassess the association of initial congenital cataract surgery times, compliance to amblyopia therapy, and visual outcomes for a long-term follow-up in a secondary IOL implantation. Methods Retrospective review of records of all infants with congenital cataracts who underwent secondary IOL implantation in the Eye and ENT Hospital of Fudan University from January 1, 2001, to December 31, 2007, and the minimum follow-up period was 5 years. Multiple regression analysis was used and the possible confounding factors were also analyzed to assess the effect on visual outcome. Results A total of 110 patients (male: 59.1%) were included. The median (min-max) age at cataract extraction and IOL implantation was 7.5 (3.0-15.0) and 35.0 (22.0-184.0) months, respectively, and the average follow-up period was 99.3 ± 23.6 months. The median (min-max) BCVA at final follow-up was 0.20 (0.01-1.00). Compliance to amblyopia therapy was none, poor, and good in 21.8%, 24.5%, and 53.6%, respectively. Postoperative BCVA [logMAR, median (min-max) 0.70 (0.00-2.00)] linearly decreased with increasing cataract extraction time (per month) (β = 0.04, 95% CI: 0.03-0.06, p < 0.0001) in multivariable models with laterality and compliance to amblyopia therapy adjusted. Good compliance to amblyopia therapy was associated with better BCVA (logMAR) at last follow-up (β = -0.40, 95% CI = -0.53 to -0.27, p < 0.0001) with laterality, opacity type, and extraction time adjusted. Conclusions For Chinese infants with congenital cataract, an earlier primary congenital cataract surgery at an age of 3 to 15 months is associated with a better visual outcome. Good compliance to amblyopia therapy was also significant to visual outcome.
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Kemmanu V, Rathod P, Rao HL, Muthu S, Jayadev C. Management of cataracts and ectopia lentis in children: Practice patterns of pediatric ophthalmologists in India. Indian J Ophthalmol 2017; 65:818-825. [PMID: 28905824 PMCID: PMC5621263 DOI: 10.4103/ijo.ijo_896_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose: To analyze the current practice patterns of Indian pediatric ophthalmologists in the management of lens anomalies. This study was conducted in a tertiary eye care hospital and involved an online questionnaire survey for practicing pediatric ophthalmologists in India. Methods: A questionnaire was devised by the authors, which included the various options available for the management of lens anomalies in children. The questionnaire was sent to each of them using an online portal. Commercial software (Stata ver. 13.1; StataCorp, College Station, TX, USA) was used for statistical analysis. Results: In unilateral cataracts in children aged <6 months, 85.42% of surgeons did not prefer to insert an intraocular lens (IOL). In the age group of 6–12 months, almost half of them preferred to insert an IOL. In the age group of 12–24 months and >24 months, 92.63% and 88.54%, respectively, preferred to insert an IOL. In bilateral cataracts, in children aged <6 months, 91.84% of surgeons did not prefer to insert an IOL, whereas in the age group of 6–12 months, 69.39% did not prefer to insert an IOL. In the age group of 12–24 months and >24 months, 80.61% and 90.82%, respectively, preferred to insert an IOL. Seventy-four percent of surgeons preferred to use a single-piece hydrophobic acrylic IOL. Conclusion: The management of lens anomalies by pediatric ophthalmologists in India varies with laterality and appears to be comparable to that followed worldwide.
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Affiliation(s)
- Vasudha Kemmanu
- Department of Pediatric Ophthalmology and Strabismus, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Pragnya Rathod
- Department of Pediatric Ophthalmology and Strabismus, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Harsha L Rao
- Department of Glaucoma Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sumitha Muthu
- Department of Pediatric Ophthalmology and Strabismus, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Chaitra Jayadev
- Department of Vitreo-Retina Services, Narayana Nethralaya, Bengaluru, Karnataka, India
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Yeh AG, Kong L, Yen KG. Long-term Outcomes of Primary Intraocular Lens Implantation in Patients Aged 7 to 24 Months. J Pediatr Ophthalmol Strabismus 2017; 54:149-155. [PMID: 28537643 DOI: 10.3928/01913913-20170206-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/21/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To report long-term outcomes of primary intraocular lens (IOL) placement in patients aged 7 to 24 months. METHODS This was a retrospective study of 27 consecutive patients (28 eyes) aged 7 to 24 months who underwent cataract surgery with primary IOL placement. RESULTS Average follow-up was 62.7 ± 41.7 months and the mean age of surgery was 14.4 ± 5.6 months. Mean final visual acuity was 1.02 ± 0.72 logMAR (20/209). Adverse events occurred in 7 eyes (25%) and included visual axis opacification in 6 eyes and pupillary block glaucoma in 1 eye. Seven patients (25.9%) required additional intraocular surgery. Strabismus was present in 19 patients (70.4%). Better stereopsis was correlated with better final acuity. CONCLUSIONS Cataract surgery with IOL placement in patients aged 7 to 24 months is associated with few complications. Visual axis opacification is the most frequent adverse event. [J Pediatr Ophthalmol Strabismus. 2017;54(3):149-155.].
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Kumar P, Lambert SR. Evaluating the evidence for and against the use of IOLs in infants and young children. Expert Rev Med Devices 2016; 13:381-9. [PMID: 26878234 PMCID: PMC4860524 DOI: 10.1586/17434440.2016.1153967] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Congenital cataracts account for 5-20% of childhood blindness worldwide. In the US, the prevalence of visually significant infantile cataracts is anywhere from 3-4 per 10,000 live births. Infantile cataracts need to be removed early in life in order to prevent the onset of deprivation amblyopia. As a result, cataract surgery is usually performed between age 4-8 weeks depending on the laterality and severity of the cataract. Given advances in the field, pediatric cataract surgery is now a safe and effective intervention for infants, but good visual outcomes require occlusion therapy and optical correction. This review will address current perspectives on the use of intraocular lenses to optically correct infants and young children after cataract surgery, as well as novel designs for intraocular lenses and directions for future research.
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Affiliation(s)
- Priyanka Kumar
- a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA
| | - Scott R Lambert
- a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA
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Complications and visual outcomes after secondary intraocular lens implantation in children. Am J Ophthalmol 2015; 159:720-6. [PMID: 25579641 DOI: 10.1016/j.ajo.2015.01.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/02/2015] [Accepted: 01/02/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate safety and visual outcomes in surgically aphakic children undergoing secondary intraocular lens (IOL) implantation. DESIGN Retrospective, consecutive, interventional case series. METHODS One hundred seventy-four eyes of 104 children (70 bilateral, 34 unilateral) who underwent secondary IOL implantation for aphakia after congenital cataract surgery at L. V. Prasad Eye Institute, Hyderabad, India, were analyzed. A minimum of 3 months of follow-up after surgery was required for inclusion in the study. Eyes with aphakia after surgery for traumatic cataracts and other associated ocular comorbidities were excluded. Main outcome measures were intraoperative and postoperative complications and visual outcome at the last follow-up. RESULTS Mean age at secondary IOL implantation was 6.08 ± 3.75 years. The mean follow-up was 25.7 ± 24.9 months. Mean best-corrected visual acuity improved from 1.08 ± 0.65 in aphakic children to 0.55 ± 0.51 logarithm of the minimal angle of resolution in pseudophakic children at last follow-up (P < .0001). Overall, 51 eyes (35%) attained a final best-corrected visual acuity of 20/40 (0.3 logarithm of the minimal angle of resolution) or better, whereas only 2 eyes (8.7%) attained a final best-corrected visual acuity of 20/40 (0.3 logarithm of the minimal angle of resolution) or better in children who underwent secondary IOL implantation for unilateral aphakia. The most common postoperative complications were secondary membrane formation (17 eyes; 9.77%), optic capture (15 eyes; 8.6%), IOL decentration (9 eyes; 5.17%), and secondary glaucoma (11 eyes; 5%). CONCLUSIONS Secondary sulcus IOL implantation in children is a relatively safe procedure and leads to favorable visual postoperative outcomes.
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Li Q, Fu T, Li ZE, Bi HS, Wang XR, Dong M, Xin T. Optical correction of aphakia following unilateral infantile cataract removal. Acta Ophthalmol 2014; 92:e657-62. [PMID: 24930475 DOI: 10.1111/aos.12465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/08/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare primary intra-ocular lens (IOL) implantation with use of press-on spherical lens for aphakia correction following unilateral infantile cataract removal. METHODS Sixty infants with a unilateral cataract underwent cataract surgery and were randomly assigned to the IOL (A group) or no IOL group (B group). Residual refractive error was corrected with spectacles in the A group and a press-on spherical lens was used to treat aphakia in the B group. Grating visual acuity (VA) was measured and patients were followed for up to 1 year. RESULTS LogMAR VA in the operated eyes of both groups was significantly better 1 year than 1 month after surgery. Mean logMAR VA difference between 1 year and 1 month after surgery was higher in the A group (0.457 ± 0.110) than in the B group (0.323 ± 0.114, p < 0.0001). Serious inflammation occurred significantly more often in the A group than in the B group (p = 0.007). Visual axis opacity occurred more often in the A group than in the B group (pupillary membrane: A: six eyes, 20%, B: none, p = 0.024; lens reproliferation: A: 10 eyes, 33%, B: two eyes, 7%, p = 0.021). Glaucoma occurred equally in both groups (p = 0.612). No other complications occurred. CONCLUSIONS Primary IOL implantation appears to be a relatively safe, effective optical correction strategy following unilateral cataract extraction in this age group. Patients for whom an IOL is not suitable can be treated with a press-on spherical lens for optical correction.
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Affiliation(s)
- Qian Li
- Shandong University of Traditional Chinese Medicine; Jinan China
- Department of Ophthalmology; The Second People's Hospital of Jinan; Jinan China
| | - Te Fu
- Department of Ophthalmology; The Second People's Hospital of Jinan; Jinan China
| | - Zhong-En Li
- Department of Ophthalmology; Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine; Jinan China
| | - Hong-Sheng Bi
- Department of Ophthalmology; Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine; Jinan China
| | - Xing-Rong Wang
- Department of Ophthalmology; Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine; Jinan China
| | - Min Dong
- Department of Ophthalmology; The Second People's Hospital of Jinan; Jinan China
| | - Tian Xin
- Department of Ophthalmology; The Second People's Hospital of Jinan; Jinan China
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A safe technique for in-the-bag intraocular lens implantation in pediatric cataract surgery. Eur J Ophthalmol 2014; 25:57-9. [PMID: 25044136 DOI: 10.5301/ejo.5000502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a safe technique for in-the-bag intraocular lens (IOL) implantation in pediatric cataract patients who undergo lens aspiration with primary posterior capsulorhexis and anterior vitrectomy. METHODS Sixty eyes of 45 consecutive patients with congenital/developmental cataract underwent lens aspiration with primary posterior continuous curvilinear capsulorhexis (PCCC) with anterior vitrectomy and in-the-bag IOL implantation using the described technique of IOL implantation using anterior capsule as support. RESULTS All eyes had stable IOL at the end of surgery and none of the eyes had lens decentration/dislocation in posterior vitreous. CONCLUSIONS Implantation of in-the-bag IOL is difficult in children who undergo primary PCCC with anterior vitrectomy. Our technique of implanting IOL by pushing it against the back surface of anterior capsule is a safe method and results in no complications related to faulty IOL implantation.
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Hydrophobic acrylic versus polymethyl methacrylate intraocular lens implantation following cataract surgery in the first year of life. Graefes Arch Clin Exp Ophthalmol 2014; 252:1443-9. [PMID: 24947548 DOI: 10.1007/s00417-014-2689-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/25/2014] [Accepted: 05/28/2014] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate complication rates following implantation of hydrophobic acrylic versus polymethyl methacrylate (PMMA) intraocular lens (IOL) with cataract surgery in infants. METHODS Records of children undergoing cataract surgery with IOL implantation in first year of life were retrospectively reviewed. Infants were divided into two groups--hydrophobic acrylic IOLs were implanted in group A, and PMMA IOLs in group B. Outcome measures included incidence of complications, additional surgical procedures, and refractive error changes. RESULTS One hundred and thirteen eyes of 113 children (75 males) with mean age of 6.49 ± 3.56 months were included. Group A included 62 eyes, and group B included 51 eyes. The two groups did not differ significantly in terms of age and axial length. There was no significant difference between the groups for incidence of posterior capsular opacification (PCO), pupillary membranes, glaucoma, fibrin on IOL surface or IOL malposition (p = 0.09). Development of PCO was delayed in group A (p = 0.049). Thirteen eyes of group A and 18 eyes of group B required additional surgical intervention (p = 0.20) in the follow-up visits. CONCLUSION Comparable complications may be expected in infants with PMMA and hydrophobic acrylic lenses. Children implanted with PMMA IOLs may require earlier surgical re-intervention for PCO.
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Celano M, Hartmann EE, Drews-Botsch CD. Parenting stress in the infant aphakia treatment study. J Pediatr Psychol 2013; 38:484-93. [PMID: 23475835 DOI: 10.1093/jpepsy/jst009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate parenting stress following infants' cataract extraction surgery, and to determine if levels of stress differ between 2 treatments for unilateral congenital cataract in a randomized clinical trial. METHODS At surgery, an intraocular lens (IOL) was implanted or children were left aphakic, treated with contact lens (CL). Stress measures were administered 3 months after surgery and at the first visit after the visual acuity (VA) assessment done at 12 months of age. RESULTS Caregivers in the IOL group reported higher levels of stress than those in the CL group 3 months after surgery, but there were no group differences in stress scores at the post-VA assessment. Stress scores did not change differentially for participants assigned to IOL versus CL treatments. CONCLUSIONS Treatment assignment did not have a significant impact on caregiver stress during infancy or on the change in stress during the child's first 2 years of life.
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Affiliation(s)
- Marianne Celano
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30303, USA.
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Shenoy BH, Mittal V, Gupta A, Sachdeva V, Kekunnaya R. Refractive outcomes and prediction error following secondary intraocular lens implantation in children: a decade-long analysis. Br J Ophthalmol 2013; 97:1516-9. [PMID: 23467789 DOI: 10.1136/bjophthalmol-2012-302775] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the refractive outcomes, prediction error (PE) and factors affecting PE in children with aphakia following congenital cataract surgery undergoing secondary intraocular lens (IOL) implantation. METHODS We analysed the records of children less than 16 years old who underwent secondary IOL implantation for aphakia following congenital cataract surgery. PE and absolute PE for each case calculated 3 months following secondary IOL implantation were analysed. Multiple regression analysis was performed to determine the relationship between age at secondary IOL implantation, axial length, keratometry readings and PE. RESULTS 174 eyes of 104 children were analysed. Mean age at surgery was 6.08±3.75 years. The mean PE was 1.65±2.46 dioptres (D) (range -3.25 to 7.5 D) and mean absolute PE was 2.15±1.68 D (range 0-7.5 D) at 3 months. There was a statistically significant difference in absolute PE between eyes in which IOL calculation was performed using IOL master (1.80±1.40 D) versus IOL calculation under general anaesthesia with contact method (2.43±1.83 D), p=0.01. Multiple regression analysis revealed an inverse relationship between age at secondary IOL implantation and mean absolute PE (p=0.01). CONCLUSIONS IOL power calculation with SRK II formula with sulcus placement of IOL gives favourable refractive outcomes. Though age-based refraction is targeted, a significant PE may be expected.
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Affiliation(s)
- Bhamy Hariprasad Shenoy
- Pediatric Ophthalmology and Strabismus Services, Jasti V Ramanamma Children's Eye Care Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, , Hyderabad, Andhra Pradesh, India
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Shangwa NI. Global Health and the Surgeon 2013 Winning Abstract – Surgical Outcomes of Infantile Cataract Surgery. Ann Med Surg (Lond) 2013. [DOI: 10.1016/s2049-0801(13)70029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Hafidi Z, Ibrahimy W, Ahid S, Handor H, Cherkaoui LO, Bencherif Z, Laghmari M, Ouazzanni B, Boutimzine N, Daoudi R. [Visual prognosis and refractive outcome after congenital cataract surgery with primary implantation: a study of a series of 108 cases]. Pan Afr Med J 2013; 16:51. [PMID: 24672622 PMCID: PMC3964010 DOI: 10.11604/pamj.2013.16.51.2713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 10/02/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Zouheir Hafidi
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Wafaa Ibrahimy
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Samir Ahid
- Université Mohammed V Souissi, laboratoire de biostatistiques, faculté de médecine, Rabat, Maroc
| | - Hanan Handor
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Lalla Ouafae Cherkaoui
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Zahid Bencherif
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Mina Laghmari
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Btissam Ouazzanni
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Noureddine Boutimzine
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Rajae Daoudi
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
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Pehere NK, Bojja S, Vemuganti GK, Vaddavalli PK, Samant M, Jalali S, Bhate M. Opacification of intraocular lenses implanted during infancy: a clinicopathologic study of 4 explanted intraocular lenses. Ophthalmology 2011; 118:2128-2132.e1. [PMID: 21862135 DOI: 10.1016/j.ophtha.2011.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 03/21/2011] [Accepted: 05/02/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To report the clinicopathologic features of 4 opacified, single-piece, hydrophilic, acrylic intraocular lenses (IOLs) explanted from children who had undergone IOL implantation during infancy. DESIGN Observational case series. PARTICIPANTS Four IOLs explanted from 4 eyes of 3 children for visually significant opacification were included in the study. METHODS The clinical details of each case were obtained to look for possible risk factors for IOL opacification. The explanted IOLs were subjected to gross examination, staining by alizarin red 1% for calcium, scanning electron microscopy, and energy-dispersive x-ray spectroscopy (EDS). Levels of calcium and phosphorous were analyzed in the serum of all cases and in the aqueous humor of 1 case. MAIN OUTCOME MEASURES Morphologic features and composition of deposits. RESULTS Two cases had congenital cataract while one case was after bilateral lens sparing vitrectomy for retinopathy of prematurity. All underwent surgery during infancy with implantation of an IOL. The IOLs were explanted 8 months after surgery from 4 eyes of 3 children at the age of 17, 25, and 26. All the children received a single-piece hydrophilic acrylic IOL. The IOLs were in situ for an average duration of 13.86 months. The deposits were in the shape of a bicycle wheel on 3 IOLs and looked like fish eggs on 1 IOL. All deposits stained bright orange with alizarin red. On EDS, the deposits were found to be composed of calcium, phosphate, and silicone. CONCLUSIONS The morphologic features and composition of IOL deposits in 2 cases were similar to those of earlier reports in adults. The hydrophilic nature of the IOL material, sulcus implantation, and postoperative inflammation may be possible risk factors for opacification. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Niranjan K Pehere
- The David Brown Children's Eye Care Center, L.V. Prasad Eye Institute, Vijayawada, India
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Abdelmoaty SMA, Behbehani AH. The outcome of congenital cataract surgery in Kuwait. Saudi J Ophthalmol 2011; 25:295-9. [PMID: 23960940 DOI: 10.1016/j.sjopt.2011.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 01/02/2011] [Accepted: 01/07/2011] [Indexed: 10/18/2022] Open
Abstract
AIM Congenital cataract is the most common cause of treatable blindness in children and the outcome of congenital cataract surgery has not been studied in Kuwait, so the purpose of this study is to evaluate the visual outcome and the postoperative complications. METHODS Medical records of children who underwent congenital cataract surgery between September 2000 and December 2008 at Al-Bahar Eye Center, Ministry of Health of Kuwait were retrospectively reviewed. In 100 eyes that fill the inclusion criteria visual acuity and postoperative complications were recorded. The mean follow up was 3.9 ± 1.7 years with range from 3 to 6 years. RESULTS The mean age of congenital/developmental cataract surgery is 8.9 ± 8.7 months for bilateral cases and it was 5.75 ± 4.61 months for unilateral cases. The mean final postoperative BCVA in unilateral cases was 1.0 (20/200) log MAR unit and it was 0.3 (20/40) log MAR unit for the bilateral cases. Four percent of the cases developed postoperative glaucoma and 2% of them developed significant opacification of the posterior capsule. CONCLUSION Our findings provide evidence of recent improvement over time in the visual prognosis in bilateral, and to a lesser degree, unilateral cataract, in children in Kuwait.
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Lee CK, Kim SS, Kim WS. Glaucoma Following Pediatric Cataract Surgery: Incidence and Risk Factors. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.10.1150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chang-Kyu Lee
- Department of Ophthalmology, Maryknoll Hospital, Busan, Korea
| | - Sang-Soo Kim
- Department of Ophthalmology, Maryknoll Hospital, Busan, Korea
| | - Wan-Soo Kim
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Bothun ED, Johnson CS, Archer SM, Del Monte MA. Evolution of postoperative astigmatism after large incision PMMA lens implantation in children. J AAPOS 2010; 14:518-21. [PMID: 21147009 DOI: 10.1016/j.jaapos.2010.09.007] [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: 05/08/2010] [Revised: 09/13/2010] [Accepted: 09/14/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the evolution of postoperative astigmatism after cataract extraction and lens implantation in children through a 6.5 mm limbal incision. METHODS This is a retrospective longitudinal study of consecutive pediatric patients with adequate follow-up who underwent cataract extraction with intraocular lens implantation through a 6.5 mm limbal incision. Preoperative and 3-month postoperative astigmatism and spherical equivalent were compared. RESULTS A total of 92 eyes of 73 children met the inclusion criteria. The mean cylindrical correction on the first postoperative day was 6.6 ± 2.3 D (range, 1.00-13.00 D). This dropped to 1.9 ± 1.7 D between 2 and 4 weeks and 1.2 ± 1.0 D (range, 0-3.25 D) by 3 months postoperatively. The mean spherical equivalent was +0.5 D on the first postoperative day and did not change significantly during the follow-up period. The mean astigmatism preoperatively (1.2 ± 0.8 D) and 3 months postoperatively (1.2 ± 1.0 D) were not statistically different (p = 0.9). There was no statistically significant change in astigmatism between 1 and 3 months and 1 and 2 years (p = 0.16, n = 33). CONCLUSIONS Large cylindrical refractive errors after pediatric cataract surgery through a 6.5 mm limbal incision resolve postoperatively within 3 months.
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Affiliation(s)
- Erick D Bothun
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, USA
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Jasman AA, Shaharuddin B, Noor RAM, Ismail S, Ghani ZA, Embong Z. Prediction error and accuracy of intraocular lens power calculation in pediatric patient comparing SRK II and Pediatric IOL Calculator. BMC Ophthalmol 2010; 10:20. [PMID: 20738840 PMCID: PMC2936388 DOI: 10.1186/1471-2415-10-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 08/25/2010] [Indexed: 11/30/2022] Open
Abstract
Background Despite growing number of intraocular lens power calculation formulas, there is no evidence that these formulas have good predictive accuracy in pediatric, whose eyes are still undergoing rapid growth and refractive changes. This study is intended to compare the prediction error and the accuracy of predictability of intraocular lens power calculation in pediatric patients at 3 month post cataract surgery with primary implantation of an intraocular lens using SRK II versus Pediatric IOL Calculator for pediatric intraocular lens calculation. Pediatric IOL Calculator is a modification of SRK II using Holladay algorithm. This program attempts to predict the refraction of a pseudophakic child as he grows, using a Holladay algorithm model. This model is based on refraction measurements of pediatric aphakic eyes. Pediatric IOL Calculator uses computer software for intraocular lens calculation. Methods This comparative study consists of 31 eyes (24 patients) that successfully underwent cataract surgery and intraocular lens implantations. All patients were 12 years old and below (range: 4 months to 12 years old). Patients were randomized into 2 groups; SRK II group and Pediatric IOL Calculator group using envelope technique sampling procedure. Intraocular lens power calculations were made using either SRK II or Pediatric IOL Calculator for pediatric intraocular lens calculation based on the printed technique selected for every patient. Thirteen patients were assigned for SRK II group and another 11 patients for Pediatric IOL Calculator group. For SRK II group, the predicted postoperative refraction is based on the patient's axial length and is aimed for emmetropic at the time of surgery. However for Pediatric IOL Calculator group, the predicted postoperative refraction is aimed for emmetropic spherical equivalent at age 2 years old. The postoperative refractive outcome was taken as the spherical equivalent of the refraction at 3 month postoperative follow-up. The data were analysed to compare the mean prediction error and the accuracy of predictability of intraocular lens power calculation between SRK II and Pediatric IOL Calculator. Results There were 16 eyes in SRK II group and 15 eyes in Pediatric IOL Calculator group. The mean prediction error in the SRK II group was 1.03 D (SD, 0.69 D) while in Pediatric IOL Calculator group was 1.14 D (SD, 1.19 D). The SRK II group showed lower prediction error of 0.11 D compared to Pediatric IOL Calculator group, but this was not statistically significant (p = 0.74). There were 3 eyes (18.75%) in SRK II group achieved acccurate predictability where the refraction postoperatively was within ± 0.5 D from predicted refraction compared to 7 eyes (46.67%) in the Pediatric IOL Calculator group. However the difference of the accuracy of predictability of postoperative refraction between the two formulas was also not statistically significant (p = 0.097). Conclusions The prediction error and the accuracy of predictability of postoperative refraction in pediatric cataract surgery are comparable between SRK II and Pediatric IOL Calculator. The existence of the Pediatric IOL Calculator provides an alternative to the ophthalmologist for intraocular lens calculation in pediatric patients. Relatively small sample size and unequal distribution of patients especially the younger children (less than 3 years) with a short time follow-up (3 months), considering spherical equivalent only.
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Affiliation(s)
- Azlyn-Azwa Jasman
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Lambert SR, Buckley EG, Drews-Botsch C, DuBois L, Hartmann EE, Lynn MJ, Plager DA, Wilson ME. A randomized clinical trial comparing contact lens with intraocular lens correction of monocular aphakia during infancy: grating acuity and adverse events at age 1 year. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 2010; 128:810-8. [PMID: 20457949 PMCID: PMC3512571 DOI: 10.1001/archophthalmol.2010.101] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare the visual outcomes and adverse events of contact lens with primary intraocular lens (IOL) correction of monocular aphakia during infancy. METHODS In a randomized, multicenter (12 sites) clinical trial, 114 infants with a unilateral congenital cataract were assigned to undergo cataract surgery between 1 to 6 months of age either with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Grating visual acuity was tested at 1 year of age by a masked traveling examiner. MAIN OUTCOME MEASURE Grating visual acuity at 1 year of age. RESULTS The median logMAR visual acuity was not significantly different between the treated eyes in the 2 groups (contact lens group, 0.80; IOL group, 0.97; P = .19). More patients in the IOL group underwent 1 or more additional intraocular operations than patients in the contact lens group (63% vs 12%; P < .001). Most of these additional operations were performed to clear lens reproliferation and pupillary membranes from the visual axis. CONCLUSIONS There was no statistically significant difference in grating visual acuity at age 1 year between the IOL and contact lens groups; however, additional intraocular operations were performed more frequently in the IOL group. APPLICATION TO CLINICAL PRACTICE Until longer-term follow-up data are available, caution should be exercised when performing IOL implantation in children aged 6 months or younger given the higher incidence of adverse events and the absence of an improved short-term visual outcome compared with contact lens use.
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Ziakas NG, Vartholomaiou AN. Simultaneous surgery in bilateral congenital cataract. Eur J Ophthalmol 2010; 20:629-30; author reply 630. [PMID: 20408128 DOI: 10.1177/112067211002000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lu Y, Ji YH, Luo Y, Jiang YX, Wang M, Chen X. Visual results and complications of primary intraocular lens implantation in infants aged 6 to 12 months. Graefes Arch Clin Exp Ophthalmol 2010; 248:681-6. [PMID: 20162296 DOI: 10.1007/s00417-010-1310-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 12/10/2009] [Accepted: 01/14/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To present the visual results and the complications of primary intraocular lens (IOL) implantation in infants aged 6 to 12 months between January 2002 and July 2007. METHODS A total of 26 consecutive eyes, of 16 infants with cataract aged 6 to 12 months, were reviewed in the study. All patients had cataract extraction with anterior and posterior capsulorrhexis combined with anterior vitrectomy and primary hydrophobic acrylic IOL implantation. Six infants (six eyes) had unilateral congenital cataract and ten (20 eyes), bilateral cataract. Visual acuity and complications were recorded throughout the 46.4-month mean follow-up (range 22 to 79 months). RESULTS All eyes had primary IOL implantation. The mean best-corrected visual acuity (logMAR) was 0.98 +/- 0.18,0.50 +/- 0.14 and 0.61 +/- 0.25 for unilateral, bilateral and all eyes respectively at the last follow-up. IOLs were implanted in the capsular bag of 25 eyes (96.2%) and in the sulcus of the remaining one eye (3.8%). Seven eyes (26.9%) developed visual axis opacification (VAO), and four eyes required secondary pars plana vitrectomy (PPV). IOL opacification occurred in one eye 54 months after implantation. Late onset open-angle glaucoma developed in one eye, and required trabeculectomy surgery. The predictors of good best-corrected visual acuity (BCVA) included partial cataract, bilateral cataract, absence of strabismus or nystagmus, and good amblyopic treatment. The greatest annual myopic change (5.15 +/- 2.08 D) was observed during the first 12 months after surgery. In unilateral cases, there was no significant difference in the axial length between the cataractous eye and the fellow normal eye both at the time of surgery (P = 0.891) and final follow-up (P = 0.693). CONCLUSIONS Primary IOL implantation was safe and effective for infantile cataract surgery. Total or unilateral cataract, nystagmus or strabismus, and inadequate amblyopic therapy were predictors of poor BCVA. Significant myopic shifts occurred especially in infants in the first year of surgery. The pseudophakic eye had a similar growth rate, as measured by axial length, to that of the fellow normal eye, in unilateral cases.
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Affiliation(s)
- Yi Lu
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China.
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Lambert SR, Buckley EG, Drews-Botsch C, DuBois L, Hartmann E, Lynn MJ, Plager DA, Wilson ME. The infant aphakia treatment study: design and clinical measures at enrollment. ACTA ACUST UNITED AC 2010; 128:21-7. [PMID: 20065212 DOI: 10.1001/archophthalmol.2009.350] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare the use of contact lenses and intraocular lenses (IOLs) for the optical correction of unilateral aphakia during infancy. METHODS In a randomized, multicenter (12 sites) clinical trial, 114 infants with unilateral congenital cataracts were assigned to undergo cataract surgery with or without IOL implantation. Children randomized to IOL treatment had their residual refractive error corrected with spectacles. Children randomized to no IOL treatment had their aphakia treated with a contact lens. MAIN OUTCOME MEASURES Grating acuity at 12 months of age and HOTV visual acuity at 4 1/2 years of age. APPLICATION TO CLINICAL PRACTICE This study should determine whether either treatment for an infant with a visually significant unilateral congenital cataract results in a better visual outcome. RESULTS Enrollment began December 23, 2004, and was completed January 16, 2009. The median age at the time of cataract surgery was 1.8 months. Fifty patients were 4 to 6 weeks of age at the time of enrollment; 32, 7 weeks to 3 months of age; and the remaining 32, more than 3 to less than 7 months of age. Fifty-seven children were randomized to each treatment group. Eyes with cataracts had shorter axial lengths and steeper corneas on average than the fellow eyes. CONCLUSIONS The optimal optical treatment of aphakia in infants is unknown. However, the Infant Aphakia Treatment Study was designed to provide empirical evidence of whether optical treatment with an IOL or a contact lens after unilateral cataract surgery during infancy is associated with a better visual outcome.
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Pediatric intraocular lens implantation: historic perspective and current practices. Int Ophthalmol Clin 2010; 50:71-80. [PMID: 20057297 DOI: 10.1097/iio.0b013e3181c5676b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Onol M, Ozdek S, Aktas Z, Hasanreisoglu B. Long-term results of pars plana lensectomy with double-capsule-supported intraocular lens implantation in children. Can J Ophthalmol 2008; 43:673-7. [PMID: 19020633 DOI: 10.3129/i08-139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND To report the long-term results of the pars plana lensectomy with double-capsule-supported intraocular lens implantation technique for the treatment of pediatric cataracts. METHODS A lensectomy and an anterior vitrectomy were performed through the pars plana approach, followed by implantation of a posterior chamber intraocular lens (IOL) to the sulcus over the capsules. Patients with a minimum follow-up of 5 years were included in the study and patient data were collected retrospectively from the patient reports. RESULTS Sixteen eyes of 10 patients with a mean age of 4.3 (SD 1.1) years were included in the study. Only one case was traumatic, and the others were congenital cataract cases. A 6.5 mm polymethyl methacrylate posterior chamber IOL was used in all cases. The visual axis was clear in all the cases through the mean follow-up period of 79.2 (SD 14.1) months. IOL decentration was observed in 1 eye at postoperative month 24, and it needed to be repositioned. There was no posterior capsular opacification in any of the cases. Best-corrected visual acuity was 20/40 or better in 81.3% of the eyes. INTERPRETATION The pars plana lensectomy with double-capsule-supported intraocular lens implantation technique seems to be a safe and easy method in children, limiting postoperative IOL-related complications and posterior capsule opacification in the long term.
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Affiliation(s)
- Merih Onol
- Department of Ophthalmology, Gazi University Medical Faculty, Ankara, Turkey
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Eibschitz-Tsimhoni M, Tsimhoni O, Archer SM, Del Monte MA. Effect of axial length and keratometry measurement error on intraocular lens implant power prediction formulas in pediatric patients. J AAPOS 2008; 12:173-6. [PMID: 18423341 DOI: 10.1016/j.jaapos.2007.10.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 10/15/2007] [Accepted: 10/26/2007] [Indexed: 12/28/2022]
Abstract
PURPOSE To examine the relationship between axial length and keratometry measurement errors and intraocular lens (IOL) power calculations for pediatric eyes. METHODS The sensitivity of IOL power calculation to errors in axial length and keratometry measurements was computed as a function of axial length and keratometry for the SRK II, Hoffer Q, Holladay I, SRK/T, and Haigis formulas. RESULTS The sensitivity of the IOL power calculation to an axial length measurement error is increased at 4 to 14 D/mm error in axial length in children compared with 3 to 4 D/mm error in axial length in adults. The error in calculation is 0.8 to 1.3 D/D error in keratometry measurement for both children and adults. CONCLUSIONS Axial length measurement errors in pediatric eyes may lead to large errors in IOL power calculations.
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Affiliation(s)
- Maya Eibschitz-Tsimhoni
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.
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Abstract
With improving surgical technique and equipment, the acceptable age for placing an intraocular lens in infants and children is becoming younger. The tools for predicting intraocular lens power have not necessarily kept up, as current theoretical and regression intraocular lens power prediction formulas are largely based on adult eyes at axial lengths, anterior chamber depth, and keratometric values much different than those seen in infants. In addition, the adult eye has matured and is no longer growing, whereas the eyes of infants and children may continue to note changes in axial length, keratometric values, and possibly optical characteristics. Another source of error in intraocular lens power selection that is more likely to occur in pediatric patients than in adult patients is inaccuracy in measurement of axial length or keratometric power. A review of current tools and considerations for intraocular lens power prediction in infants and children is presented.
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Affiliation(s)
- Maya Eibschitz-Tsimhoni
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
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Ledoux DM, Trivedi RH, Wilson ME, Payne JF. Pediatric cataract extraction with intraocular lens implantation: visual acuity outcome when measured at age four years and older. J AAPOS 2007; 11:218-24. [PMID: 17306994 DOI: 10.1016/j.jaapos.2006.11.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 10/31/2006] [Accepted: 11/01/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE Assessment of visual outcome of pediatric eyes that underwent cataract extraction with primary intraocular lens (IOL) implantation at a single center. METHODS A retrospective review of charts of 510 consecutive pediatric patients that underwent cataract extraction was performed. Exclusion criteria were traumatic cataract, secondary IOL implantation, retinopathy of prematurity, severe developmental delay, age less than 4 years at last follow-up, and follow-up less than 6 months. In bilateral cases, only right eye data were included. RESULTS One hundred thirty-nine eyes met inclusion criteria. Median age at surgery was 5.12 years (range, 0.03-16.92); median age at last follow-up was 9.05 years, and median follow-up was 3.65 years. Sixty-six of 139 (47.5%) patients had unilateral cataracts compared with 73/139 (52.5%) bilateral cases. The median visual acuity of all eyes was 20/30, with median visual acuity of unilateral and bilateral cases being 20/40 and 20/25, respectively. Older patients achieved better visual acuity (unilateral cases: p = 0.003; bilateral cases: p = 0.07). Eyes with a greater interocular axial length difference achieved poorer visual acuity. Forty-five patients had a final visual acuity worse than 20/40. Of these, 34 (76%) had a diagnosis of amblyopia as the sole cause. Nineteen of 139 (13.7%) eyes had final visual acuity worse than 20/200. Eighteen patients required strabismus surgery, and 22 required additional intraocular surgery. CONCLUSIONS Better visual acuity was associated with bilateral cataract, older age at surgery, and normal interocular axial length difference. Amblyopia was the major cause of residual visual deficit.
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Affiliation(s)
- Danielle M Ledoux
- Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina
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Eibschitz-Tsimhoni M, Tsimhoni O, Archer SM, Del Monte MA. Discrepancies between Intraocular Lens Implant Power Prediction Formulas in Pediatric Patients. Ophthalmology 2007; 114:383-6. [PMID: 17270686 DOI: 10.1016/j.ophtha.2006.06.063] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Revised: 06/09/2006] [Accepted: 06/28/2006] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The SRK II, SRK/T, Holladay I, and Hoffer Q intraocular lens power prediction formulas have been claimed to be interchangeable in their predicted postoperative refractive outcome among pediatric patients. In this study, we evaluated this clinical perception. DESIGN Mathematical analysis. METHODS Analytical prediction of implant power using keratometry values up to 55 diopters and axial length values as short as 16 mm was performed for 2 different refractive goals using the optimized intraocular lens constants for the SRK II, SRK/T, Holladay I, Hoffer Q, and Haigis formulas. Comparison graphs for the predicted implant power of each formula were constructed and differences between predicted results of the formulas were plotted. MAIN OUTCOME MEASURE Predicted implant power. RESULTS Significant differences in intraocular lens power prediction were found among the Hoffer Q, Holladay I, and SRK II formulas in the pediatric range of axial length and keratometry values. The Holladay I and Haigis formulas were found to be similar in their intraocular lens power prediction. The SRK/T was comparable with the Holladay I and Haigis formulas, but still differed in the high keratometry values. CONCLUSIONS This analysis demonstrates differences in the intraocular lens power prediction among commonly used formulas for axial length and keratometry values in the pediatric range. It is unclear under what circumstances each of these formulas may be preferred in the pediatric population.
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Affiliation(s)
- Maya Eibschitz-Tsimhoni
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan 48105, USA.
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Dolan LA, Donnelly MJ, Spratt KF, Weinstein SL. Professional opinion concerning the effectiveness of bracing relative to observation in adolescent idiopathic scoliosis. J Pediatr Orthop 2007; 27:270-6. [PMID: 17414008 PMCID: PMC4668936 DOI: 10.1097/01.bpb.0000248579.11864.47] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine if community equipoise exists concerning the effectiveness of bracing in adolescent idiopathic scoliosis. BACKGROUND DATA Bracing is the standard of care for adolescent idiopathic scoliosis despite the lack of strong reasearch evidence concerning its effectiveness. Thus, some researchers support the idea of a randomized trial, whereas others think that randomization in the face of a standard of care would be unethical. METHODS A random of Scoliosis Research Society and Pediatric Orthopaedic Society of North America members were asked to consider 12 clinical profiles and to give their opinion concerning the radiographic outcomes after observation and bracing. RESULTS An expert panel was created from the respondents. They expressed a wide array of opinions concerning the percentage of patients within each scenario who would benefit from bracing. Agreement was noted concerning the risk due to bracing for post-menarchal patients only. CONCLUSIONS : This study found a high degree of variability in opinion among clinicians concerning the effectiveness of bracing, suggesting that a randomized trial of bracing would be ethical.
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Affiliation(s)
- Lori A Dolan
- Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, Iowa City, IA 52242, USA.
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Fan DSP, Yip WWK, Yu CBO, Rao SK, Lam DSC. Updates on the Surgical Management of Paediatric Cataract with Primary Intraocular Lens Implantation. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n8p564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
With the advent of modern surgical techniques, paediatric cataract has become much more manageable. Intraocular lens (IOL) implantation is the standard of care for patients over the age of 2 years. The use of IOL in young infants is still controversial. In addition, there are still unresolved issues, such as the minimum age at which IOL can be safely implanted, IOL power selection and IOL power calculation. The current trends in the management of the above challenges are discussed. Although numerous reports on the prevention and management of posterior capsule opacification have been published, there are ongoing intensive debates and research. Long-term postoperative complications like glaucoma and rhegmatogenous retinal detachment are problems that cannot be overemphasised and these issues are also reviewed.
Key words: Congenital cataract, Intraocular lens, Posterior capsule opacification
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Affiliation(s)
| | - Wilson WK Yip
- The Chinese University of Hong Kong, Kowloon, Hong Kong
| | | | | | - Dennis SC Lam
- The Chinese University of Hong Kong, Kowloon, Hong Kong
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Yang ML, Hou CH, Lee JS, Liang YS, Kao LY, Lin KK. Clinical characteristics and surgical outcomes of pediatric cataract in Taiwan. Graefes Arch Clin Exp Ophthalmol 2006; 244:1485-90. [PMID: 16628419 DOI: 10.1007/s00417-006-0308-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 01/07/2006] [Accepted: 02/10/2006] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To report treatment of pediatric patients with cataract, and evaluate the efficiency of different surgical interventions. METHOD This study comprised a consecutive series of pediatric patients with congenital or developing cataract who received surgery between 1993 and 2002 at Chang Gung Memorial Hospital in Taiwan. Patients' demographics, cataract type, presenting symptoms, surgical intervention, postoperative visual acuity, and follow-up refractive changes were recorded. RESULTS Three hundred and ninety-nine eyes of 246 children were included; unilateral cataract was present 21.8% of the eyes. The age at surgery was ranged from 1 to 157 months. Eyes were grouped by surgical interventions performed: Group 1 included 98 eyes that had lensectomy. Group 2 included 89 eyes that had lensectomy and secondary intraocular lens implantation. Group 3 included 212 eyes that had lensectomy with primary intraocular implantation. The mean follow up time was 41.3 months. Finally, 23.1% group 1 patients, 42.1% group 2 patients, and 63.4% group 3 patients achieved visual acuity better than 20/60 (P=0.000). Upon analysis with multifactor regression, age at onset (P=0.011) was the only significant factor related to visual outcome. Complications such as after cataract and glaucoma occurred in 21.6% and 5.8% of all patients, respectively. CONCLUSIONS Intraocular lens implantation for children with congenital or developing cataract is an effective treatment for visual rehabilitation, even for those patients age 2 years and younger.
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Affiliation(s)
- Meng-Ling Yang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fu-Shing Street, Kweishan 333, Taoyuan, Taiwan, Republic of China
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Affiliation(s)
- Sharola Dharmaraj
- Department of Pediatric Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
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Birch EE, Cheng C, Stager DR, Felius J. Visual acuity development after the implantation of unilateral intraocular lenses in infants and young children. J AAPOS 2005; 9:527-32. [PMID: 16414517 DOI: 10.1016/j.jaapos.2005.07.008] [Citation(s) in RCA: 29] [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: 03/09/2005] [Accepted: 07/25/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE Intraocular lenses (IOLs) are now being implanted in infants and children with unilateral cataracts. However, there are no prospective data on the development of visual acuity after implantation. The aim of the present study was to prospectively assess the development of acuity in infants and preschool children who received IOLs or aphakic contacts lenses (CLs) after the extraction of a unilateral cataract. METHODS Visual acuity was assessed using Teller Acuity Cards and/or crowded HOTV tests at target ages of 6 months, 1, 2, 3, and 4 years. RESULTS Infants who received a primary IOL after extraction of dense congenital unilateral cataract (n = 5) showed improvement from an initially low mean visual acuity of 20/170 at 6 months to 20/85 at 12 months and 20/54 at 4 years. Visual acuity in the IOL group was similar to that of children who had good-to-excellent compliance with CL wear (n = 36; 4-year visual acuity 20/50) and better than that of children who had moderate-to-poor compliance (n = 11; 4-year visual acuity 20/135). Children who received IOLs after extraction of developmental unilateral cataracts by 6 months (n = 4; 4-year visual acuity 20/55) had visual acuity development similar to those treated with CLs (n = 5; 4-year visual acuity 20/55). Children who received IOLs after extraction of developmental unilateral cataracts after 1 year of age (n = 18) had better visual acuity than children those treated with CLs (n = 4) at 4 years of age (20/40 vs. 20/135). CONCLUSION IOLs and aphakic CLs support similar visual acuity development after surgery for a unilateral cataract. IOLs may support better visual acuity development when compliance with CL wear is moderate to poor or when a cataract is extracted after 1 year of age.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas 75231, USA.
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