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Zedan R, Farag CS, Gouda J, Awadein A, Elhilali H, Hassanein DH. Outcome of intraocular lens exchange for the management of myopic shift in pseudophakic children. Eur J Ophthalmol 2024; 34:1029-1035. [PMID: 38055956 DOI: 10.1177/11206721231218299] [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] [Indexed: 12/08/2023]
Abstract
PURPOSE To evaluate the visual outcome of intraocular lens (IOL) exchange for the management of myopic shift in pseudophakic children. METHODS The medical records of children who underwent IOL exchange for myopic shift were examined. The preoperative data, operative details and the postoperative outcome were analyzed. RESULTS Twenty-one eyes (16 patients) were identified. Mean age at cataract extraction was 20 ± 26 months (range, 2-84 months). Twelve patients (6 unilateral, 6 bilateral) had primary IOL implantation. Mean age at IOL exchange was 7.3 ± 3.2 years. Mean spherical equivalent (SE) at IOL exchange was -14 ± 5 D (range, -7 to -21 D): Mean SE at IOL exchange was -13.64 ± 4.99 D, -12 ± 1.53 D, and -15.5 ± 4.7 D in unilaterally pseudophakic cases (8 patients), in the eye that underwent unilateral IOL exchange (3 patients) in bilaterally pseudophakic cases, and in bilateral IOL exchange cases (5 patients), respectively. Mean axial length at IOL exchange was 24 ± 1.3 mm (range, 23 to 27 mm). Following IOL exchange, mean SE was reduced to -2 ± 1.8 D (range, -4 to +2.5 D). An average of three logMAR line improvement in the best-corrected visual acuity was observed in 12/16 eyes of patients for whom pre- and post-exchange visual acuity were available, while visual acuity remained unchanged in 4 eyes. Mean logMAR visual acuity improvement was 0.35 and 0.49 in unilateral and bilateral pseudophakic cases, respectively. CONCLUSIONS IOL exchange is a safe procedure that should be considered to improve visual rehabilitation in pseudophakic patients with myopic shift.
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Affiliation(s)
- Rasha Zedan
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Christina S Farag
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Jylan Gouda
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Awadein
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hala Elhilali
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina H Hassanein
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Chen ZX, Jia WN, Ma Y, Chen TH, Hong JH, Sun Y, Liu Y, Song LH, Jiang YX. Predicting axial length in patients with Marfan syndrome and ectopia lentis after modified capsular tension ring and intraocular lens implantation. J Cataract Refract Surg 2023; 49:571-577. [PMID: 36745849 DOI: 10.1097/j.jcrs.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To predict the growth of axial length (AL) in patients with Marfan syndrome (MFS) and ectopia lentis (EL). SETTING Eye and ENT Hospital of Fudan University, Shanghai, China. DESIGN Consecutive retrospective case series. METHODS Eyes were evaluated that had modified capsular tension ring and intraocular lens (IOL) implantation. The rate of AL growth (RALG) was calculated using AL divided by log10-transformed age. A multivariate linear regression model of RALG was developed after validation. RESULTS 128 patients with MFS and EL were enrolled with a median follow-up duration of about 3 years. RALG was independent of age between 3 years and 15 years old ( P = .799) and decreased to 0 thereafter ( P = .878). Preoperative AL was associated with RALG in patients under 15 years old ( P = .003). Beta values for the final model of RALG were as below: intercept (-9.794) and preoperative AL (0.664). The postoperative AL was predicted as: postAL = preAL + RALG × log 10 ([postAge + 0.6]/[preAge + 0.6]). The mean prediction error was -0.003 (95% CI, -0.386 to 0.3791) mm and the mean absolute percentage error was 1.93% (95% CI, 0.73% to 3.14%). A Python-based calculator was developed to use the predicted AL in selecting IOL power and setting undercorrection. CONCLUSIONS The AL growth of patients with MFS followed a logarithmic pattern and ceased at about age 15. A prediction model of postoperative AL was established for individual MFS patients between 3 and 15 years old, which could potentially optimize the IOL power selection.
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Affiliation(s)
- Ze-Xu Chen
- From the Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China (Z.-X. Chen, Jia, Ma, T.-H. Chen, Sun, Liu, Song, Jiang); NHC Key Laboratory of Myopia, Fudan University; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China (Z.-X. Chen, Jia, Ma, T.-H. Chen, Sun, Liu, Song, Jiang); Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China (Z.-X. Chen, Jia, Ma, T.-H. Chen, Sun, Liu, Song, Jiang); School of Computer Science, Fudan University Shanghai, China (Hong)
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Park Y, Yum HR, Shin SY, Park SH. Ocular biometric changes following unilateral cataract surgery in children. PLoS One 2022; 17:e0272369. [PMID: 35930578 PMCID: PMC9355217 DOI: 10.1371/journal.pone.0272369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose To analyze ocular biometric changes following unilateral cataract surgery in children. Methods A total of 57 children aged under 13 years who underwent unilateral cataract surgery were analyzed. Groups were classified according to their age at surgery: group I (age <3), II (3≤ age <6), III (6≤ age <9), and IV (age ≥9). The myopic shift, axial growth, and corneal curvature changes were compared between the pseudophakic eyes and the fellow phakic eyes. Results During 7.81 ± 4.39 years, the overall myopic shift (D) and the rate of myopic shift (D/year) were significantly higher at -3.25 ± 3.21 D and -0.45 ± 0.44 D/year in the pseudophakic eyes than -1.78 ± 2.10 D and -0.22 ± 0.29 D/year in the fellow phakic eyes (P = 0.01, 0.004). Group I (-1.14 ± 0.66 vs -0.02 ± 0.45 D/year) and group II (-0.63 ± 0.37 vs -0.31 ± 0.29 D/year) showed significantly higher rate of myopic shift in the pseudophakic eyes than in the phakic eyes. The rate of myopic shift in the pseudophakic eyes decreased in the older age groups (P = 0.001). There was no significant between-eye difference in the changes in axial length and keratometric values postoperatively. Conclusion Following unilateral cataract surgery, a significant postoperative myopic shift was noticed in the pseudophakic eyes compared to the fellow phakic eyes in groups under 6 years old. Postoperative myopic shift and the resultant anisometropia should be considered when selecting the optimal power of IOL in young children requiring unilateral cataract surgery.
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Affiliation(s)
- Yooyeon Park
- Department of Ophthalmology, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Hae Ri Yum
- Department of Ophthalmology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Young Shin
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shin Hae Park
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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VanderVeen DK, Oke I, Nihalani BR. Deviations From Age-Adjusted Normative Biometry Measures in Children Undergoing Cataract Surgery: Implications for Postoperative Target Refraction and IOL Power Selection. Am J Ophthalmol 2022; 239:190-201. [PMID: 35278359 DOI: 10.1016/j.ajo.2022.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate whether pediatric eyes that deviate from age-adjusted normative biometry parameters predict variation in myopic shift after cataract surgery. METHODS This is a single institution longitudinal cohort study combining prospectively collected biometry data from normal eyes of children <10 years old with biometry data from eyes undergoing cataract surgery. Refractive data from patients with a minimum of 5 visits over ≥5 years of follow-up were used to calculate myopic shift and rate of refractive growth. Cataractous eyes that deviated from the middle quartiles of the age-adjusted normative values for axial length and keratometry were studied for variation in myopic shift and rate of refractive growth to 5 years and last follow-up visit. Multivariable analysis was performed to determine the association between myopic shift and rate of refractive growth and factors of age, sex, laterality, keratometry, axial length, intraocular lens power, and follow-up length. RESULTS Normative values were derived from 100 eyes; there were 162 eyes in the cataract group with a median follow-up of 9.6 years (interquartile range: 7.3-12.2 years). The mean myopic shift ranged from 5.5 D (interquartile range: 6.3-3.5 D) for 0- to 2-year-olds to 1.0 D (interquartile range: 1.5-0.6 D) for 8- to 10-year-olds. Multivariable analysis showed that more myopic shift was associated with younger age (P < .001), lower keratometry (P = .01), and male gender (P = .027); greater rate of refractive growth was only associated with lower keratometry measures (P = .001). CONCLUSIONS Age-based tables for intraocular lens power selection are useful, and modest adjustments can be considered for eyes with lower keratometry values than expected for age.
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Sun J, Zhang J, Dai Y, Wan X, Xie L. Cataract surgery contributes to ocular axis growth of aphakic eyes in infants with complex microphthalmos. Medicine (Baltimore) 2020; 99:e22140. [PMID: 32991407 PMCID: PMC7523844 DOI: 10.1097/md.0000000000022140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
To observe the ocular axis, visual acuity and intraocular pressure (IOP) of aphakic eye in infants with congenital cataract and complex microphthalmos after first-stage cataract surgery.This retrospective study included infants with congenital cataract and operated at the Qingdao Eye Hospital between January 2010 and December 2014. The infants were divided into 2 groups: preoperative axial length <18 mm (microphthalmos) or ≥18 mm (controls). Follow-up lasted 24 months; visual acuity, axial length, and IOP were evaluated.There were 28 infants (55 eyes) in the microphthalmos group and 35 (61 eyes) in the control group. The preoperative visual acuity was negative for optokinetic nystagmus, while the postoperative visual acuity was positive for optokinetic nystagmus in both groups. The growth rate was higher in the microphthalmos group (1.4 ± 0.8 vs 0.8 ± 0.4 mm/yr, P < .001 vs controls). The axial length was smaller in the microphthalmos group at all time points compared with the control group (all P < .001). There was no changes in IOP in the microphthalmos group from baseline to 24 months (P = .147), but the IOP was slightly decreased in the control group (P = .015).Cataract surgery may contribute to ocular axis growth in infants with complex microphthalmos.
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Affiliation(s)
- Jinfeng Sun
- Qingdao Eye Hospital, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao
- Department of Ophthalmology, Yantaishan Hospital, Yantai, Shandong
| | - Jing Zhang
- Qingdao Eye Hospital, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao
| | - Yunhai Dai
- Qingdao Eye Hospital, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao
| | - Xiaomei Wan
- Qingdao Eye Hospital, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao
| | - Lixin Xie
- Qingdao Eye Hospital, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao
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Wilson ME, Trivedi RH, Weakley DR, Cotsonis GA, Lambert SR. Globe Axial Length Growth at Age 10.5 Years in the Infant Aphakia Treatment Study. Am J Ophthalmol 2020; 216:147-155. [PMID: 32304705 DOI: 10.1016/j.ajo.2020.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the change in globe axial length (AL) from the time of unilateral cataract surgery at age 1-7 months to age 10.5 years for infants enrolled in the Infant Aphakia Treatment Study, and to compare AL growth of operated eyes with that of fellow unoperated eyes. DESIGN Comparative case series. METHODS AL growth was analyzed relative to treated vs fellow eye, contact lens (CL) vs intraocular lens (IOL), visual acuity (VA) outcome, and the need for surgery for visual axis opacification. Eyes with glaucoma or glaucoma suspect were excluded from the primary analysis but reported separately. RESULTS Fifty-seven patients have reliable AL data available at both visits. AL was shorter in treated eyes preoperatively (P < .0001) and at 10.5 years of age (P = .021) but AL growth was not different (4.7 mm, P = .99). The growth (70.2% up to age 5 and 29.8% from age 5 to 10.5) was similar in the CL and the IOL group (P = .79). Eyes grew 4.4 mm when visual acuity (VA) was better than 20/200, and 5.2 mm when VA was 20/200 or worse (P = .076). Eyes receiving additional surgery grew more than eyes not receiving additional surgery (P = .052). Patients with glaucoma showed significantly more eye growth (7.3 mm) than those without glaucoma (4.7 mm) and glaucoma suspects (5.1 mm) (P < .05). CONCLUSIONS Eyes with glaucoma or poor VA often grew longer than the fellow eye. Overall, treated eyes grew similarly in the IOL and CL groups and also kept pace with the growth of the fellow eyes.
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Zhu X, He W, Du Y, Kraus CL, Xu Q, Sun T, Yu J, Lu Y. Presence of Posterior Staphyloma in Congenital Cataract Children. Curr Eye Res 2019; 44:1319-1324. [PMID: 31246115 DOI: 10.1080/02713683.2019.1637437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose: To investigate the prevalence of posterior staphyloma (PS) in congenital cataract children and its role in predicting postoperative axial elongation.Materials and Methods: Preoperative prevalence of PS in 520 congenital cataract patients was reviewed and compared with that of the healthy eyes of 300 unilateral traumatic cataract children after 1:1 propensity score matching. Then, 32 pseudophakic children with preoperative PS and 48 age-matched pseudophakic controls without preoperative PS were followed up after the surgery, to compare their axial growth rates and refractive changes.Results: Congenital cataract was significantly associated with the presence of PS (OR: 14.88, P = .009) after propensity score matching. Even in congenital cataract eyes with axial length <26 mm, 5% were identified with PS on B-scan: ≤22 mm: 3%, 22-24 mm: 5% and 24-26 mm: 13%. Eyes with preoperative PS exhibited faster postoperative axial growth than those without, especially in bilateral cases or in children undergoing surgery before 8 years old (≤4 years: 0.53 ± 0.33 vs 0.30 ± 0.21 mm/y P = .028; 4-8 years: 0.37 ± 0.26 vs 0.23 ± 0.15 mm/y P = .044). Myopic shift after surgery was also more significant in children with preoperative PS than in those without (-1.10 ± 0.50 vs -0.60 ± 0.47D/y, P < .001).Conclusions: Congenital cataract is a risk factor for PS. Preoperative PS in pediatric cataract eyes may be an indicator of excessive postoperative axial elongation, especially in bilateral cases or in cases undergoing cataract surgery at a younger age. Our findings may also promote better clinical decision-making in intraocular lens power selection for pediatric population.
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Affiliation(s)
- Xiangjia Zhu
- Department of Ophthalmology, Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wenwen He
- Department of Ophthalmology, Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yu Du
- Department of Ophthalmology, Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Courtney L Kraus
- Pediatric Ophthalmology and Adult Strabismus Krieger Children's Eye Center, Wilmer Eye Institute, Wilmer, TX, USA
| | - Qingguo Xu
- School of Pharmacy, Virginia Commenwealth University, Richmond, VA, USA
| | - Ting Sun
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Jia Yu
- Department of Ophthalmology, Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yi Lu
- Department of Ophthalmology, Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Seven E, Tekin S, Batur M, Artuç T, Yaşar T. Evaluation of changes in axial length after congenital cataract surgery. J Cataract Refract Surg 2019; 45:470-474. [PMID: 30661967 DOI: 10.1016/j.jcrs.2018.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 08/14/2018] [Accepted: 11/18/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate the relationship between lens status and axial length (AL) in patients operated for unilateral and bilateral congenital cataract. SETTING Yüzüncü Yıl University, Ophthalmology Clinic, Van, Turkey. DESIGN Retrospective study. METHODS Records of patients who underwent surgery for unilateral or bilateral congenital cataract were analyzed. The patients were separated into three groups: bilateral aphakic, bilateral pseudophakic, and unilateral. The unilateral group was subdivided into the operated cataract eyes (unilateral aphakic and unilateral pseudophakic) and unoperated fellow phakic eyes. The patients' age at surgery, follow-up time, preoperative and postoperative AL measurements, change in AL, and monthly growth rate were evaluated. RESULTS The bilateral aphakic group included 40 eyes of 20 patients, the bilateral pseudophakic group included 103 eyes of 54 patients, and the unilateral group included 40 eyes of 20 patients. The mean age at time of surgery in these groups was 8.17 months ± 10.65 (SD), 42.47 ± 43.81 months, and 42.47 ± 43.81 months, respectively. There were no significant differences in preoperative AL, postoperative AL, change in AL, or monthly growth rate between the aphakic and fellow phakic eyes in the unilateral group (P > .05). There were also no significant differences between unilateral pseudophakic eyes and fellow phakic eyes in the unilateral group with respect to preoperative AL or change in AL, but there were significant differences in final AL and monthly growth rate (P < .05). CONCLUSIONS Various factors can affect axial elongation. The monthly growth rate was lower in pseudophakic eyes compared with phakic eyes. Experimental studies are required to understand the mechanism underlying this effect.
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Affiliation(s)
- Erbil Seven
- Department of Ophthalmology, Faculty of Medicine, Yüzüncü Yıl University, Van, Turkey.
| | - Serek Tekin
- Department of Ophthalmology, Faculty of Medicine, Yüzüncü Yıl University, Van, Turkey
| | - Muhammed Batur
- Department of Ophthalmology, Faculty of Medicine, Yüzüncü Yıl University, Van, Turkey
| | - Tuncay Artuç
- Department of Ophthalmology, Faculty of Medicine, Yüzüncü Yıl University, Van, Turkey
| | - Tekin Yaşar
- Department of Ophthalmology, Beyoglu Eye and Research Hospital, Istanbul, Turkey
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Negalur M, Sachdeva V, Neriyanuri S, Ali MH, Kekunnaya R. Long-term outcomes following primary intraocular lens implantation in infants younger than 6 months. Indian J Ophthalmol 2018; 66:1088-1093. [PMID: 30038148 PMCID: PMC6080482 DOI: 10.4103/ijo.ijo_182_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: To study the long-term safety profile and visual outcomes of primary intraocular lens (IOL) implantation in infants <6 months of age. Methods: This was a retrospective observational study conducted at a tertiary eye care center in South India. Infants under 6 months meeting the selection criteria who underwent cataract surgery (lens aspiration, primary posterior capsulorhexis, and anterior vitrectomy) with primary IOL implantation between January 2008 and December 2011 and minimum 3-year follow-up were included. Patient demographics, serial refractions, visual acuity, complications, and associated amblyopia/strabismus were reviewed. Visual acuity, myopic shift, and complications were the outcome measures. Results: Sixty-nine eyes of 38 infants (31 bilateral; mean age: 4.6 months) were reviewed. Mean follow-up was 51 months (range: 36–84). Median logMAR best-corrected visual acuity at the final visit was 0.74 (interquartile range [IQR]: 0.50–0.98) in eyes with bilateral cataracts and 0.87 (IQR: 0.60–1.14) in eyes with unilateral cataracts with an average myopic shift of 6.7 diopters over 4.2 years. Most common postoperative complication was visual axis opacification (VAO) (13 eyes, 18%), necessitating membranectomy followed by pigmentary IOL deposits (11 eyes, 15%), and IOL decentration and glaucoma in four eyes each (5.6%). Mixed linear effect model found no significant association of age, gender, laterality, and postoperative complications with final visual acuity (P ≥ 0.05). Eyes with unilateral cataracts had a greater myopic shift than bilateral cases (P = 0.03). Conclusion: Primary IOL implantation in infants <6 months is reasonably safe in appropriately selected infants. VAO was the most common postoperative complication, and a large myopic shift was observed.
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Affiliation(s)
- Mithila Negalur
- Department of Pediatric Ophthalmology, Strabismus, and Neuro-Ophthalmology, Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virender Sachdeva
- Department of Pediatric Ophthalmology, Strabismus, and Neuro-Ophthalmology, Nimmagada Prasad Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Srividya Neriyanuri
- Centre for Clinical Epidemiology and Biostatistics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mohammed Hasnat Ali
- Department of Pediatric Ophthalmology, Strabismus, and Neuro-Ophthalmology, Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ramesh Kekunnaya
- Department of Pediatric Ophthalmology, Strabismus, and Neuro-Ophthalmology, Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Valera Cornejo DA, Flores Boza A. Relationship between preoperative axial length and myopic shift over 3 years after congenital cataract surgery with primary intraocular lens implantation at the National Institute of Ophthalmology of Peru, 2007-2011. Clin Ophthalmol 2018; 12:395-399. [PMID: 29503527 PMCID: PMC5826293 DOI: 10.2147/opth.s152560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective To determine the relationship between the preoperative axial length and the myopic shift over 3 years after congenital cataract surgery with primary intraocular lens implantation and other related factors. Methods In this retrospective cohort study, the axial length was measured and assigned into 2 groups (>21.5 mm and ≤21.5 mm), visual axis obscuration, laterality of cataract, age of surgery and follow-up time were assessed and compared to the myopic shift. Results The mean myopic shift was 3.6 (standard deviation [SD]: 2.3) diopters (D) in all patients; 3.2 (3.3) and 3.9 (3.2) D for each group respectively (p=0.359). In unilateral cataracts the mean myopic shift was 6.3 D and in bilateral cases was 3.0 D (p=0.001). In bilateral cataracts, the shift was 2.6 D (SD: 2.0) and 3.4 D (SD: 1.8), respectively (p=0.098). Conclusion There was no relationship between the initial axial length and the myopic shift in all patients. Unilateral cataracts had a greater myopic shift over 3 years.
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Affiliation(s)
| | - Abel Flores Boza
- Pediatric Ophthalmology Department, National Institute of Ophthalmology of Peru, Lima, Peru
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Wilson ME, Trivedi RH, Weakley DR, Cotsonis GA, Lambert SR. Globe Axial Length Growth at Age 5 Years in the Infant Aphakia Treatment Study. Ophthalmology 2017; 124:730-733. [PMID: 28196730 DOI: 10.1016/j.ophtha.2017.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To report the longitudinal change in axial length (AL) from the time of unilateral cataract surgery at age 1 to 7 months to age 5 years, and to compare AL growth of operated eyes with that of fellow unoperated eyes. DESIGN Comparative case series. PARTICIPANTS Infants enrolled in the Infant Aphakia Treatment Study (IATS). METHODS The AL at baseline and age 5 years and change in AL were analyzed relative to treated versus fellow eye, visual outcome, and treatment modality (contact lens [CL] vs. intraocular lens [IOL]). Eyes with glaucoma or glaucoma suspect were excluded from primary analysis but reported separately. MAIN OUTCOME MEASURES The AL growth from preoperative to age 5 years. RESULTS Seventy patients were eligible; however, AL data for both eyes were available for 64 patients at baseline and 69 patients at age 5 years. The AL was significantly different between treated and fellow eyes preoperatively (18.1 vs. 18.7 mm, P < 0.0001) and at the final follow-up (21.4 vs. 22.1 mm, P = 0.0004). The difference in AL growth between treated and fellow eyes was not significant (3.3 vs. 3.5 mm, P = 0.31). The change in AL in eyes was similar with both treatments (CL 3.2 mm and IOL 3.4 mm, P = 0.53) and did not correlate with visual outcomes (P = 0.85). Eyes receiving additional surgery to clear the visual axis opacification grew significantly more compared with eyes not receiving surgery to clear the visual axis (3.8 vs. 2.7 mm, P = 0.013). Patients with glaucoma showed significantly more eye growth (5.7 mm) than those without glaucoma (3.3 mm) and glaucoma suspects (4.3 mm). CONCLUSIONS Eyes treated for monocular cataract in infancy have axial growth similar to that of fellow eyes, despite having a shorter AL at the time of surgery. The change in AL in eyes was similar with both treatments (CL and IOL), did not correlate with visual outcomes, and was higher in eyes receiving additional surgery to clear the visual axis or eyes diagnosed with glaucoma.
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Affiliation(s)
- M Edward Wilson
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina.
| | - Rupal H Trivedi
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - David R Weakley
- Department of Ophthalmology, Southwestern University, Dallas, Texas
| | - George A Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
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Tadros D, Trivedi RH, Wilson ME, Davidson JD. Ocular axial growth in pseudophakic eyes of patients operated for monocular infantile cataract: a comparison of operated and fellow eyes measured at surgery and 5 or more years later. J AAPOS 2016; 20:210-3. [PMID: 27109053 DOI: 10.1016/j.jaapos.2016.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 01/05/2016] [Accepted: 01/13/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To report the change in axial length (AL) over time and to compare the percentage of AL growth of pseudophakic eyes operated on for monocular cataract to that of the unoperated fellow eyes. METHODS The medical records of children operated on by a single surgeon for monocular congenital cataract before 7 months of age were retrospectively reviewed. Inclusion criteria were corneal diameter of ≥9 mm and availability of AL data for >5 years' follow-up after cataract surgery and >1 year after IOL implantation (in case of secondary IOL). Cataract with persistent fetal vasculature causing stretching of the ciliary processes, diagnosis of glaucoma or glaucoma suspect, and eyes with aphakia were excluded. Globe AL was measured by immersion ultrasound at surgery and 5 or more years later. RESULTS A total of 24 children were identified. Average age at cataract surgery was 2.6 ± 2.1 months. Age at last follow-up was 8.4 ± 2.8 years and duration of follow-up was 8.2 ± 2.8 years. 13 eyes received a primary IOL and 11 eyes received a secondary IOL. AL was significantly different between operative and fellow eyes, preoperatively (18.1 mm vs 18.7 mm, P = 0.004), and at the final follow-up (22.2 mm vs 23.0 mm, P = 0.03). Differences in AL growth of operated and fellow eyes were not significant (4.1 mm vs 4.4 mm, P = 0.4). Similarly, percentage of AL growth of operated and fellow eyes was also not significantly different (23% vs 23.6%, P = 0.7). CONCLUSIONS Eyes operated for monocular cataract have similar axial growth to that of fellow unoperated eyes, despite having a shorter AL at the time of surgery.
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Affiliation(s)
- Dina Tadros
- Storm Eye Institute, Medical University of South Carolina, Charleston; Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Rupal H Trivedi
- Storm Eye Institute, Medical University of South Carolina, Charleston
| | - M Edward Wilson
- Storm Eye Institute, Medical University of South Carolina, Charleston.
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Borghol-Kassar R, Menezo-Rozalén JL, Harto-Castaño MA, Desco-Esteban MC. Effect of unilateral congenital cataract surgery on ocular axial length growth and corneal flattening. ACTA ACUST UNITED AC 2015; 90:106-11. [PMID: 25596651 DOI: 10.1016/j.oftal.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 06/29/2014] [Accepted: 07/08/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this article is to study the effect of unilateral congenital cataract surgery on ocular growth and corneal flattening. METHODS This is a cross-sectional study of 59 patients operated on due to a unilateral congenital cataract. The median age of the patients at the time of diagnosis was 17 months (interquartile range, 5-39 months). The median age at cataract the time of surgery was 28 months (interquartile range, 8-52 months), and the mean follow-up between cataract surgery and assessments was 149.7±69.9 months (range, 30-319 months). Axial length and corneal curvature were measured in both operated and non-operated eyes, comparing the results between them. RESULTS There were no statistically significant differences for axial length growth or corneal flattening between operated and non-operated eyes: axial length (P=.327, Student t test) and corneal curvature (P=.078, Student t test). A sub-analysis was performed using the visual acuity and the age of the patient at the time of surgery. The only statistically significant data (P=.007, Student t test) was a lower axial length in operated eyes compared to non-operated eyes, in the non-deep-amblyopia group. CONCLUSIONS No significant axial length growth modifications were observed between operated and non-operated eyes. Only the non-deep-amblyopia group presented with a lower axial length in the operated eyes compared to non-operated eyes. No significant differences in corneal flattening were found between groups after unilateral congenital cataract surgery.
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Affiliation(s)
| | | | - M A Harto-Castaño
- Unidad de de Oftalmología Pediátrica, Hospital Universitari La Fe, Valencia, España
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Abstract
PURPOSE A key issue in managing children with cataract is to determine whether the eye is of normal axial length for the age of the child. This is important in both prognostication and selection of an appropriate intraocular lens in congenital cataract cases. The aim of this study was to assess the axial lengths recorded for the apparently normal eyes in patients with unilateral congenital cataracts. METHODS The notes of all patients who had undergone cataract surgery in the last 5 years for unilateral congenital cataract were analyzed and the preoperative data were obtained. Only the contralateral noncataractous eyes with long-term normal visual development and refractive error were included. RESULTS Twenty eyes were measured in this period. The extrapolated mean axial length at birth was 16.8 mm, with a rapid initial axial growth, with a mean axial length of 20 mm at 12 months of age and 21 mm at age 4 years. CONCLUSIONS Axial length changes rapidly in the first 18 months of life. The normal data found here at different ages may assist in interpreting perioperative measurements in such children.
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Lambert SR, Lynn MJ, DuBois LG, Cotsonis GA, Hartmann EE, Wilson ME. Axial elongation following cataract surgery during the first year of life in the infant Aphakia Treatment Study. Invest Ophthalmol Vis Sci 2012; 53:7539-45. [PMID: 23074203 DOI: 10.1167/iovs.12-10285] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To compare ocular axial elongation in infants after unilateral cataract surgery corrected with a contact lens (CL) or primary intraocular lens (IOL) implantation. METHODS Baseline axial length (AL) was measured at the time of cataract surgery (1-6 months) and at age 1 year. AL at baseline and age 1 year and the change in length/mo were analyzed in relation to treatment modality, cataractous versus fellow eye, and age at surgery using linear mixed models. RESULTS Mean baseline AL did not differ between the CL and IOL groups for either cataractous or fellow eyes. Eyes with cataracts were shorter than fellow eyes by an average of 0.6 mm (95% confidence interval [CI], 0.4-0.8 mm; P < 0.0001). For the operated eyes, the mean change in AL/mo was smaller in the CL group (0.17 mm/mo) than in the IOL group (0.24 mm/mo) (P = 0.0006) and was independent of age at surgery (P = 0.19). In contrast, the change in AL/mo for fellow eyes decreased with older age at surgery (P < 0.0001). At age 1 year, operated eyes treated with a CL were 0.6 mm shorter on average than operated eyes treated with an IOL (P = 0.009). CONCLUSIONS At baseline, eyes with cataracts were shorter than fellow eyes. The change in AL/mo was smaller in operated eyes treated with a CL than in operated eyes treated with an IOL, but was not significantly related to age at surgery. (ClinicalTrials.gov number, NCT00212134.).
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Affiliation(s)
- Scott R Lambert
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
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Current world literature. Curr Opin Ophthalmol 2009; 21:81-90. [PMID: 19996895 DOI: 10.1097/icu.0b013e3283350158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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