The effects of surgical factors on postoperative astigmatism in patients enrolled in the Infant Aphakia Treatment Study (IATS)

Management of Contact Lenses and Visual Development in Pediatric Aphakia

Congenital cataract is among the main causes of treatable vision loss in childhood. The first weeks and months of life are a critical time for the development of vision. Therefore, early cataract surgery and effective multifaceted treatment of the resulting aphakia in the early stages of life are of great value for the management of vision development. Among the treatment models, contact lenses (CL) have an important place in infancy and early childhood up to the age of 2 years. Although good visual gains were not considered very likely, especially in unilateral aphakia, important steps have been taken in the treatment of pediatric aphakia thanks to the surgical techniques developed over time and the increasing experience with optical correction systems, especially CLs. This review examines current developments in the types of CL used in pediatric aphakia, their application features, comparison with other optical systems, the features of amblyopia treatment in the presence of CL, and the results obtained with family compliance to CL wear and occlusion therapy in the light of existing studies.

Biometry and corneal aberrations after cataract surgery in childhood

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.

Axial Length Shortening After Cataract Surgery: New Approach to Solve the Question

Purpose

To check if optical biometry can detect eventual corneal power (Km) and axial length (AL) cataract surgery-related changes that could influence the refractive outcome.

Methods

Patients scheduled for sequential bilateral cataract surgery between January and September 2017 were included in the present study. One hundred ninety-six eyes of 98 patients (48 males) were selected. Before surgery of the first eye, patients underwent a complete ophthalmic examination, including IOLMaster biometry; the same evaluations were repeated in both eyes the day before the fellow eye cataract surgery, performed at least 2 months after the first one. The differences in Km and AL in the first operated eyes were evaluated, and the fellow eyes were used as controls.

Results

Km differences in the operated eyes ranged from −1.97 to +0.98 diopter (D) (mean = −0.02 ± 0.36 D) (P = 0.89); in the nonoperated eyes they ranged from −0.6 to +0.7 D (mean = 0 ± 0.20 D) (P = 0.91). The AL differences (pseudophakic option) in the operated eyes ranged from −0.35 to +0.15 mm (mean = −0.10 ± 0.08 mm) (P < 0.001); with the aphakic option they ranged from −0.24 to + 0.26 mm (mean = 0.01 ± 0.08 mm) (P= 0.38). In the nonoperated eyes, the AL differences ranged from −0.04 to +0.06 mm (mean= 0 ± 0.02 mm) (P = 0.02).

Conclusions

The modern phaco-technique seems not to induce changes in Km and AL, supporting the hypothesis that the differences in AL are due to an incorrect estimation in pseudophakic eyes.

Translational Relevance

The results of our study may improve the AL measurements in pseudophakic eyes.

Surgical outcomes of congenital and developmental cataracts in Japan

PURPOSE

To retrospectively analyze the surgical outcomes of congenital/developmental cataracts in Japan.

METHODS

A mail questionnaire was sent to facilities engaged in surgical treatment of congenital cataracts.

RESULTS

Twenty-nine facilities reported on 809 eyes of 508 patients with congenital/developmental cataracts. Three hundred fifty-nine eyes underwent intraocular lens implantation (pseudophakia group), while 450 eyes were left aphakic (aphakia group). The average age at surgery was significantly higher in the pseudophakia group (70 ± 53 months) than in the aphakia group (14 ± 24 months) (P < 0.0001). A significantly larger proportion of patients with unilateral cataract (52.0 %) received IOL implantation than did those with bilateral cataracts (42.6 %) (P = 0.0224). The prevalence of associated ocular disorders, such as nystagmus, microcornea, nanophthalmos, and persistent fetal vasculature, was significantly higher in the aphakia group than in the pseudophakia group. Postoperatively, glaucoma developed more frequently in the aphakia group (5.8 %) than in the pseudophakia group (0.7 %) (P = 0.0003). Posterior capsule opacification developed more frequently in the pseudophakic eyes even when both posterior capsulotomy and anterior vitrectomy were performed, especially in patients aged 1 year or younger. Postoperative visual acuity was significantly better in the pseudophakia group than in the aphakia group, both in the unilateral and in the bilateral cases.

CONCLUSIONS

Surgeons tended to select IOL implantation, rather than to leave the eye aphakic, in patients who were older at the time of surgery, had fewer coexisting ocular disorders, and suffered from unilateral cataract. Under such circumstances, pseudophakic eyes obtained significantly better postoperative visual acuity than did aphakic eyes.