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Lwowski C, Wenner Y, Kaiser KP, Sapok E, Kohnen T. Intraocular lens calculation using the ESCRS online calculator in pediatric eyes undergoing lens extraction. J Cataract Refract Surg 2024; 50:676-681. [PMID: 38407982 DOI: 10.1097/j.jcrs.0000000000001433] [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: 10/26/2023] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To evaluate the ESCRS online calculator for intraocular lens (IOL) calculation in children undergoing lens extraction and primary IOL implantation. SETTING Department of Ophthalmology, Goethe-University Frankfurt, Frankfurt am Main, Germany. DESIGN Retrospective, consecutive case series. METHODS Eyes that received phacoemulsification and IOL implantation (Acrysof SN60AT) due to congenital or juvenile cataract were included. We compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of formulas provided by the recently introduced online calculator provided by the ESCRS with the SRK/T formula, as well as the number of eyes within ±0.5 diopters (D), ±1.0 D, ±2.0 D of target refraction. Postoperative spherical equivalent was measured by retinoscopy 4 to 12 weeks postoperatively. RESULTS 60 eyes from 47 patients with a mean age of 6.5 ± 3.2 years met the inclusion criteria. Mean axial length was 22.27 ± 1.19 mm. Mean preoperative spherical equivalent (SE) was -0.25 ± 3.78 D, and mean postoperative SE was 0.69 ± 1.53 D. The MedAE was lowest in the SRK/T formula (0.56 D, ± 1.03) performed significantly better ( P = .037) than Hoffer QST and Kane, followed by BUII (0.64 D, ± 0.92), Pearl DGS (0.65 D, ± 0.94), EVO (0.69 D, ± 0.94), Hoffer QST (0.75 D, ± 0.99), and Kane (0.78 D, ± 0.99). All of those were significantly above zero ( P < .001). 41 eyes received an intraoperative optic capture (68%). When excluding eyes that did not receive intraoperative optic capture (n = 19; 32%), the MedAE was shown to be lower. CONCLUSIONS Using modern IOL calculation formulas provided by the ESCRS calculator provides good refractive predictability and compares for most of the formulas with the results with SRK/T. In addition, the formulas seem to anticipate the postoperative refraction better for eyes that receive a posterior optic capture.
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Affiliation(s)
- Christoph Lwowski
- From the Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany
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Li Y, Tan Y, Xu C, Jin G, Chen H, Jin L, Luo L, Chen W, Lin H, Liu Y, Liu Z. Association Between Preoperative Ocular Parameters and Myopic Shift in Children Undergoing Primary Intraocular Lens Implantation. Transl Vis Sci Technol 2024; 13:24. [PMID: 38809530 PMCID: PMC11146040 DOI: 10.1167/tvst.13.5.24] [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: 12/06/2023] [Accepted: 03/30/2024] [Indexed: 05/30/2024] Open
Abstract
Purpose To evaluate the association between preoperative ocular parameters and myopic shift following primary intraocular lens (IOL) implantation in pediatric cataracts. Methods Eyes from pediatric patients undergoing bilateral cataract surgery with primary IOL implantation were included. Eyes were grouped by age at surgery and subdivided into three axial length (AL) subgroups and three keratometry subgroups. Mixed-effects linear regression was utilized to assess the trend in myopic shift among subgroups. Multivariable analysis was performed to determine factors associated with myopic shift. Results A total of 222 eyes were included. The median age at surgery was 4.36 years (interquartile range [IQR], 3.16-6.00 years) and the median follow-up was 4.18 years (IQR, 3.48-4.64 years). As preoperative AL increased, a decreased trend was observed in myopic shift and rate of myopic shift (P = 0.008 and P = 0.003, respectively, in the 4 to <6 years old group; P = 0.002 and P < 0.001, respectively, in the ≥6 years old group). Greater myopic shift and rate of myopic shift were associated with younger age at surgery (P = 0.008 and P = 0.008, respectively). Both myopic shift and rate of myopic shift were negatively associated with AL. Conclusions Age at surgery and preoperative AL were associated with myopic shift in pediatric cataracts following primary IOL implantation. Adjusting the target refraction based on preoperative AL could potentially improve patients' long-term refractive outcome. Translational Relevance This study may help to guide the selection of postoperative target refraction according to age at surgery and preoperative ocular parameters for pediatric cataracts.
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Affiliation(s)
- Yunqian Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yuan Tan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Chaoqun Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Hui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Dupessey F, Dalmas F, Aziz A, Denis D, Beylerian M. A new strategy to calculate the intraocular lens power in congenital cataracts according to age and axial length at implantation. Acta Ophthalmol 2023. [PMID: 37937745 DOI: 10.1111/aos.15805] [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: 11/02/2022] [Revised: 06/21/2023] [Accepted: 10/22/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE The purpose of the study was to suggest a new method to calculate the intraocular lens (IOL) power in paediatric cataracts targeting emmetropia at the age of 15 years. METHODS Data of children younger than 15 years who underwent cataract surgery with IOL implantation between 2005 and 2020 in the ophthalmological department of Marseille (South of France) was collected retrospectively. A logarithmic regression model was used to predict the axial length growth of the included eyes between implantation and 15 years. The predicted myopic shift served as target refraction to calculate a theoretical IOL power aiming for emmetropia at 15 years. Refractive error with the theoretical lens power was estimated as the spherical equivalent at the last follow-up minus the difference of target refractions between the implanted IOL and the theoretical one. Refractive errors using Dahan, Enyedi and Trivedi guidelines were also estimated and compared to the logarithmic model. RESULTS Thirty-five eyes of 26 children were analysed. At the last follow-up, the median age of children was 10 years old and the median spherical equivalent was -1.88 dioptres (D) (IQR -3.81, -0.75). The estimated median refractive errors were 0.18 D (IQR -1.11, 1.42) with the logarithmic formula, -1.47 D (IQR -3.84, -0.65) with Dahan formula, -0.63 D (IQR -2.15, 0.32) with Enyedi formula and 0.38 D (IQR -1.58, 1.07) with Trivedi formula. CONCLUSION The estimated refractive error with the new logarithmic formula is the closest to emmetropia at the last follow-up.
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Affiliation(s)
- Florence Dupessey
- University Hospital Center of Marseille, Marseille, France
- Hôpital de la Timone, Service d'Ophtalmologie, Marseille, France
| | - Florian Dalmas
- University Hospital Center of Marseille, Marseille, France
- Hôpital Nord, Service d'Ophtalmologie, Marseille, France
| | - Aurore Aziz
- University Hospital Center of Marseille, Marseille, France
- Hôpital Nord, Service d'Ophtalmologie, Marseille, France
| | - Danièle Denis
- University Hospital Center of Marseille, Marseille, France
- Hôpital Nord, Service d'Ophtalmologie, Marseille, France
| | - Marie Beylerian
- University Hospital Center of Marseille, Marseille, France
- Hôpital Nord, Service d'Ophtalmologie, Marseille, France
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Nihalani BR, Oke I, VanderVeen DK. Comparison of baseline biometry measures in eyes with pediatric cataract to age-matched controls. Graefes Arch Clin Exp Ophthalmol 2023; 261:3007-3013. [PMID: 37233828 DOI: 10.1007/s00417-023-06122-0] [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: 01/08/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
PURPOSE To compare baseline biometry measurements in eyes with pediatric cataract versus age-matched controls METHODS: This is a cross-sectional study conducted at a tertiary care hospital that included two arms-prospective arm to collect data from normal eyes and retrospective arm for eyes with pediatric cataract. In the prospective arm, biometry measurements were obtained in healthy children aged 0 to 10 years. Children under the age of four had measurements under anesthesia for an unrelated procedure, while older children had in-office measurements using optical biometry. For comparison, biometric data was collected in children with pediatric cataract through record review. One eye of each patient was randomly selected. Axial length (AL) and keratometry (K) were compared by age and laterality. The medians were compared using Wilcoxon rank-sum tests and variances using Levene's test. RESULTS There were 100 eyes in each arm, 10 eyes in each age bin of 1-year interval. There was more variability in baseline biometry in eyes with pediatric cataract and a trend for longer AL and steeper K in cataract eyes than aged-matched controls. The difference in AL means was significant in age group 2-4 years, and variances were significant across all age groups (p=0.018). Unilateral cataracts (n=49) showed a trend toward greater variability in biometry than bilateral cataracts, but this did not reach statistical significance. CONCLUSION Baseline biometry measures are more variable in eyes with pediatric cataract compared to age-matched controls with a trend toward longer AL and steeper K.
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Affiliation(s)
- Bharti R Nihalani
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Isdin Oke
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Deborah K VanderVeen
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
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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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Kaplan AT, Yalçın SÖ, Oral AY. Primary versus secondary intraocular lens implantation following removal of congenital/de al of congenital/developmental catar elopmental cataracts: outcomes after acts: outcomes after at least 4 years. Turk J Med Sci 2023; 53:77-87. [PMID: 36945931 PMCID: PMC10388037 DOI: 10.55730/1300-0144.5560] [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: 11/15/2022] [Accepted: 02/11/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate the long-term outcomes of primary and secondary intraocular lens (IOL) implantation following removal of congenital/developmental cataracts. METHODS One hundred and forty-four patients aged under 16 years who were followed up between 2003 and 2021 were analyzed retrospectively. The long-term results of children who underwent surgery before 2 years of age for congenital or developmental cataracts and underwent secondary IOL implantation after 2 years of age and those who underwent cataract surgery with primary IOL implantation after 2 years of age were compared. Patients with traumatic, secondary cataracts and cataracts due to ocular anomalies were not included in the study. RESULTS We evaluated 64 patients (mean age 9.5 ± 4.5 years) with secondary IOL implantation and 80 patients (mean age 12.8 ± 4.1 years) with primary IOL implantation in the study. Distance and near best-corrected visual acuities were significantly better in the primary IOL group than the secondary IOL group (p < 0.001). Incidence of strabismus after primary IOL surgery was significantly lower and presence of binocular vision was more often than the secondary IOL group (p = 0.002). There was no significant difference between the two groups in terms of refraction and myopic shift (p = 0.242, p = 0.172, respectively). Mean refractive changes were significant in unilateral cases of secondary IOL group and primary IOL group (p = 0.013, p = 0.049, respectively) and myopic shift was also greater in both groups of unilateral cases than the fellow eyes (p = 0.023, p = 0.012, respectively). DISCUSSION Visual outcomes and binocular vision were better, and the incidence of strabismus was also much less in the primary IOL group.
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Affiliation(s)
- Ayşin Tuba Kaplan
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, İstanbul,Turkey
| | - Sibel Öskan Yalçın
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, İstanbul,Turkey
| | - Ayşe Yeşim Oral
- Department of Ophthalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Orazbekov L, Smagulova S, Ruslanuly K. Long-term Results of Congenital Cataract Surgery with Primary Intraocular Lens Implantation: A Case-Control Study of Three Age Groups. J Curr Ophthalmol 2022; 34:290-296. [PMID: 36644457 PMCID: PMC9832465 DOI: 10.4103/joco.joco_245_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To analyze the results of ocular refraction at the age of 7 years in children after congenital cataract surgery with intraocular lens (IOL) implantation. Methods A study of ocular biometric data of 143 eyes who underwent lens aspiration with IOL implantation in unilateral (23 eyes) and bilateral (60 eyes) congenital cataracts was performed. All children were divided into groups according to the age categories at the time of surgery: Group A (0-12 months) - 43 eyes; Group B (12-36 months) - 45 eyes; and Group C (older than 36 months) - 55 eyes. An empirical reduction of the implanted IOL power was performed: an undercorrection of 20% in children aged 0 to 36 months and 10% less in children aged 36 to 60 months. Results By age 7 years, the mean elongation ± standard deviation (SD) in Group A was 3.93 ± 1.64 mm, 2.13 ± 0.94 mm in Group B, and 0.95 ± 0.76 mm in Group C (18.7%, 9.5%, and 4.1% of the baseline axial length, respectively). There was no significant difference in axial elongation between unilateral and bilateral congenital cataracts (P = 0.32). The mean absolute refraction error (MAE) at last examination was 3.99 ± 2.12 diopter (D), 2.46 ± 1.48 D, and 1.59 ± 1.31 D in Groups A, B, and C, respectively. In infants younger than 7 months of age, by age 7 years, the mean elongation ± SD was 3.27 ± 2.86 mm (25.5%) and MAE was 3.44 ± 2.1 D. The prevalence of preoperative corneal astigmatism of 1.0 D or more was 48.95%, 2.0 D or more was 27.27%, and 3.0 D or more was 5.6%. There was no significant difference in preoperative corneal astigmatism between unilateral (1.62 ± 0.77 D) and bilateral (1.78 ± 0.90 D) congenital cataracts (P = 0.56, 95% confidence interval = -0.50-0.28). Best-corrected visual acuity (BCVA) more than 20/40 was in 53.49%, 55.55%, and 74.54% in Groups A, B, and C, respectively. Conclusions Although IOL power was calculated in accordance with children's age, at the age of 7 years, there was a different degree of ametropia because of the biometric changes of the growing eye, and a higher rate of ametropia was observed more in the younger age group than in the elder age groups.
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Affiliation(s)
- Lukpan Orazbekov
- First Ophthalmology Department, Kazakh Eye Research Institute, Almaty, Kazakhstan,Address for correspondence: Lukpan Orazbekov, First Ophthalmology Department, Kazakh Eye Research Institute, Tole Bi Street 95a, Almaty 050012, Kazakhstan. E-mail:
| | - Sabina Smagulova
- Department of Postgraduate Education, Kazakh Eye Research Institute, Almaty, Kazakhstan
| | - Kairat Ruslanuly
- Department of Postgraduate Education, Kazakh Eye Research Institute, Almaty, Kazakhstan
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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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Hansen MM, Bach-Holm D, Kessel L. Biometry and corneal aberrations after cataract surgery in childhood. Clin Exp Ophthalmol 2022; 50:590-597. [PMID: 35524701 PMCID: PMC9546075 DOI: 10.1111/ceo.14092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 01/20/2023]
Abstract
Background To report long‐term biometric and refractive outcomes in a group of Danish children after surgery for childhood cataract. Methods Children between 7 and 18 years who had undergone uni‐ or bilateral cataract surgery at the Department of Ophthalmology, Rigshospitalet, Denmark, were examined in this cross‐sectional study. Swept source optical coherence tomography (OCT) based optical biometry (IOLmaster 700) and anterior tomography (Pentacam) was performed. Healthy fellow eyes from those with unilateral cataract were used as controls. Results We included 56 children in the study with a median age at surgery of 43.8 months (1.6–137.6). The amount of higher order aberrations was significantly increased in operated eyes (median root mean square 0.461 μm [range 0.264–1.484]) compared with non‐operated eyes (median root mean square 0.337 μm [range 0.162–0.498], p < 0.001). Younger age at surgery was positively associated with more higher order aberrations at follow‐up (p < 0.001), but we found no significant associations between the amount of higher order aberrations and visual acuity or contrast vision. Longer axial length was associated to glaucoma while shorter axial length was associated to strabismus (p < 0.001). Conclusions Eyes operated for childhood cataract have higher order aberrations compared with non‐operated eyes. Higher order aberrations are complex refractive errors that cannot be corrected by normal lenses and may contribute to poor visual outcomes for the children. We found an association between young age at surgery and higher order aberrations.
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Affiliation(s)
- Mathias Møller Hansen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Daniella Bach-Holm
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Touzé R, Dureau P, Edelson C, Borella Y, Barjol A, de Laage de Meux P, Caputo G. Congenital cataract surgery: long-term refractive outcomes of a new intraocular lens power correction formula. Acta Ophthalmol 2022; 100:e1641-e1645. [PMID: 35355437 DOI: 10.1111/aos.15134] [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: 10/23/2021] [Revised: 02/27/2022] [Accepted: 03/12/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The final refraction after intraocular lens (IOL) implantation remains a challenge in the management of paediatric cataracts. No consensual guidelines exist for the choice of IOL power. The aim of this study was to validate a method of IOL power calculation by evaluating the final refractive error in all patients with IOL implantation operated at our institution. METHODS We retrospectively studied all children under 7 years of age who underwent cataract surgery with IOL implantation at our institution between 2010 and 2015. Intraocular lens (IOL) power was calculated as follows: After B-scan determination of the emmetropic IOL power, a reduction of 40%, 35%, 30%, 25%, 20%, 15%, 10% and 5% was applied to children 0-3, 3-6, 6-12, 12-18, 18-24, 24-30, 30-36, 36-48 months, respectively. The following data were collected: follow-up, age at surgery, uni- or bilaterality, implanted IOL power and final refraction. RESULTS During this period, 81 children (125 eyes) met the inclusion criteria with a median follow-up of 60 months (36-97). The median age at surgery was 6.61 months (0.76-48). We included 52 children with bilateral cataract (96 eyes) and 29 children with unilateral cataract (29 eyes). The mean implanted IOL power was 23.3 ± 4.6 diopters (D). The mean spherical equivalent at last follow-up was 0.07 ± 3.5 D. CONCLUSION Our undercorrection formula for IOL implantation after congenital cataract surgery leads to long-term refractive results globally close to emmetropia.
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Affiliation(s)
- Romain Touzé
- Pediatric Ophthalmology Department Adolphe de Rothschild Foundation Hospital Paris France
| | - Pascal Dureau
- Pediatric Ophthalmology Department Adolphe de Rothschild Foundation Hospital Paris France
| | - Catherine Edelson
- Pediatric Ophthalmology Department Adolphe de Rothschild Foundation Hospital Paris France
| | - Ysé Borella
- Pediatric Ophthalmology Department Adolphe de Rothschild Foundation Hospital Paris France
| | - Amandine Barjol
- Pediatric Ophthalmology Department Adolphe de Rothschild Foundation Hospital Paris France
| | | | - Georges Caputo
- Pediatric Ophthalmology Department Adolphe de Rothschild Foundation Hospital Paris France
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Zhong Y, Yu Y, Li J, Lu B, Li S, Zhu Y. Accuracy of Intraocular Lens Power Calculation Formulas in Pediatric Cataract Patients: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:710492. [PMID: 34901049 PMCID: PMC8661900 DOI: 10.3389/fmed.2021.710492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/21/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Among the various intraocular lens (IOL) power calculation formulas available in clinical settings, which one can yield more accurate results is still inconclusive. We performed a meta-analysis to compare the accuracy of the IOL power calculation formulas used for pediatric cataract patients. Methods: Observational cohort studies published through April 2021 were systematically searched in PubMed, Web of Science, and EMBASE databases. For each included study, the mean differences of the mean prediction error and mean absolute prediction error (APE) were analyzed and compared using the random-effects model. Results: Twelve studies involving 1,647 eyes were enrolled in the meta-analysis, and five formulas were compared: Holladay 1, Holladay 2, Hoffer Q, SRK/T, and SRK II. Holladay 1 exhibited the smallest APE (0.97; 95% confidence interval [CI]: 0.92–1.03). For the patients with an axial length (AL) less than 22 mm, SRK/T showed a significantly smaller APE than SRK II (mean difference [MD]: −0.37; 95% CI: −0.63 to −0.12). For the patients younger than 24 months, SRK/T had a significantly smaller APE than Hoffer Q (MD: −0.28; 95% CI: −0.51 to −0.06). For the patients aged 24–60 months, SRK/T presented a significantly smaller APE than Holladay 2 (MD: −0.60; 95% CI: −0.93 to −0.26). Conclusion: Due to the rapid growth and high variability of pediatric eyes, the formulas for IOL calculation should be considered according to clinical parameters such as age and AL. The evidence obtained supported the accuracy and reliability of SRK/T under certain conditions. Systematic Review Registration: PROSPERO, identifier: INPLASY202190077.
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Affiliation(s)
- Yueyang Zhong
- School of Medicine, Eye Center of the Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yibo Yu
- School of Medicine, Eye Center of the Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jinyu Li
- School of Medicine, Eye Center of the Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Bing Lu
- School of Medicine, Eye Center of the Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Su Li
- School of Medicine, Eye Center of the Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yanan Zhu
- School of Medicine, Eye Center of the Second Affiliated Hospital, Zhejiang University, Hangzhou, China
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Panahibazaz MR, Mohammadpour S, Samaeili A. Overcoming myopic shift by the initial inductive hypermetropia in pediatric cataract surgery. Indian J Ophthalmol 2021; 69:3515-3519. [PMID: 34826986 PMCID: PMC8837308 DOI: 10.4103/ijo.ijo_494_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: To assess the outcome of under-correction of intraocular lens (IOL) power in pediatric cataract surgery. Methods: We collected clinical data of 103 patients (181 eyes), all aged ≤15 years, who had undergone cataract surgery by a surgeon during 2006–2016. The mean duration of follow-up was 73 ± 38 months (range: 24–108). IOL power was calculated by Hoffer Q formula in axial length (AL) <21 mm and SRKT formula in AL ≥21 mm and then modified based on this approach: 7D initial inductive hypermetropization in children ≤1-year-old, 5D in 1–3, 3.5D in 3–5, 2.5D in 5–7, 1.5D in 7–9, 1D in 9–10, and 0 in children >10 years old. Results: The mean age of all children at surgery time was 5.85 ± 4.56 years (range: 1–178 months). There was a mean myopic shift of −6.379 D in the ≤1 year, −5.532 in the 1–3, −3.194 in the 3–5, −2.301 in the 5–7, −1.06 in the 7–9, −1.567 in the 9–10, and 0.114 in the >10-year-old age group. In 125 eyes (69.1%) of 181, the final SE was between −2 and +2 D, and 21 eyes (11.6%) achieved the goal of emmetropization. Mean best-corrected visual acuity logarithm of the minimum angle of the resolution was 0.30 in children ≤1 year, 0.39 in 1–3, 0.21 in 3–5, 0.18 in 5–7, 0.14 in 7–9, 0.16 in 9–10, and 0.11 in children >10 years old. Conclusion: This study shows a larger myopic shift in younger children. Using our approach, all age groups could finally achieve acceptable final refraction.
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Affiliation(s)
- Mahmoud Reza Panahibazaz
- Department of Ophthalmology, Faculty of Medicine, Ahwaz Jundishapur University of Medical Science; Infectious Ophthalmologic Research Center, Imam Khomeiny Hospital Research and Development Unit, Ahwaz Jundishapur University of Medical Science, Ahwaz, Iran
| | - Shirin Mohammadpour
- Department of Ophthalmology, Faculty of Medicine, Ahwaz Jundishapur University of Medical Science; Infectious Ophthalmologic Research Center, Imam Khomeiny Hospital Research and Development Unit, Ahwaz Jundishapur University of Medical Science, Ahwaz, Iran
| | - Azade Samaeili
- Department of Ophthalmology, Faculty of Medicine, Ahwaz Jundishapur University of Medical Science; Infectious Ophthalmologic Research Center, Imam Khomeiny Hospital Research and Development Unit, Ahwaz Jundishapur University of Medical Science, Ahwaz, Iran
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Xiang DM, Jiang N, Chen LH, Chen WS, Yu Y, Wang JX, He P, Xie WH. Establishing a novel lens opacities classification system based on ultrasound biomicroscopy (UBM) for pediatric cataracts: reliability and availability. Quant Imaging Med Surg 2021; 11:4594-4603. [PMID: 34737926 PMCID: PMC8511722 DOI: 10.21037/qims-20-1028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/25/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study sought to develop and validate a lens opacities classification system based on ultrasound biomicroscopy (UBM) imaging to grade pediatric cataracts. METHODS The study was conducted at Guangzhou Children's Hospital, Guangzhou Women and Children's Medical Center. UBM images of patients at the hospital from September 2013 to November 2014 were used in this study. We summarized the characteristics of lenticular opacification in each of the following 4 zones: the anterior capsule (A); the cortex (C); the nucleus (N); and the posterior capsule (P). The UBM data and intraoperative videos were compared, and sensitivity, specificity, accuracy, and positive and negative predictive values were determined for our Lens Opacities Classification System based on UBM for Pediatric Cataracts (LOCS-UP) detection. Two physicians classified pediatric cataracts (anterior capsule, cortex, and posterior capsule) by extracting 146 images from the UBM database. Patients' data were recorded to calculate the kappa coefficients. The LOCS-UP was developed. RESULTS Under this standard, all types of pediatric cataracts can be classified and acquired a code by the LOCS-UP. The LOCS-UP had the highest sensitivity (100%) and specificity (98.96%) in naming the anterior capsule and the lowest sensitivity (50%) and specificity (89.59%) in naming the posterior capsule. Its consistency at naming the anterior capsule was satisfactory (Kappa coefficient: 0.70), and it was also able to name the nucleus, cortex, and posterior capsule (0.56, 0.58, and 0.48, respectively). CONCLUSIONS LOCS-UP could name pediatric cataracts by providing an unique digital encoding, which could reflect characteristics exactly for different local lens anomalies to all kinds of pediatric cataract patients. This method provides detailed and accurate information about Patients' lenses.
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Affiliation(s)
- Dao-Man Xiang
- Department of Ophthalmology, Guangzhou Children’s Hospital, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Nan Jiang
- Department of Ophthalmology, Guangzhou Children’s Hospital, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li-Hong Chen
- Department of Ophthalmology, People’s Hospital of Longhua, Shenzhen, China
| | - Wen-Si Chen
- Department of Ophthalmology, Guangzhou Children’s Hospital, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ying Yu
- Department of Ophthalmology, Guangzhou Children’s Hospital, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jian-Xun Wang
- Department of Ophthalmology, Guangzhou Children’s Hospital, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ping He
- Department of Ophthalmology, Guangzhou Children’s Hospital, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wan-Hua Xie
- Department of Ophthalmology, Guangzhou Children’s Hospital, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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Lytvynchuk LM, Thiele MV, Schmidt W, Lorenz B. Precision of bag-in-the-lens intraocular lens power calculation in different age groups of pediatric cataract patients: Report of the Giessen Pediatric Cataract Study Group. J Cataract Refract Surg 2020; 45:1372-1379. [PMID: 31564311 DOI: 10.1016/j.jcrs.2019.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the precision of bag-in-the-lens intraocular lens (BIL IOL) power calculation in different age groups of pediatric cataract patients. SETTINGS Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany. DESIGN Retrospective nonrandomized consecutive case series. METHODS Pediatric patients diagnosed with cataract and operated with BIL IOL implantation were divided into 4 age groups: Group 1 (0 to 3 months), Group 2 (>3 months, <12 months), Group 3 (12 to 36 months), and Group 4 (>36 months to 17 years). BIL IOL power was calculated with the SRK/T formula. The prediction error (PE) was defined as the absolute difference between the preoperative selected target and postoperative achieved refraction. The impact of age at the time of surgery, axial length (AL), keratometry, and corneal astigmatism on PE was analyzed. RESULTS The study comprised 87 eyes of 56 pediatric patients. The mean and median PEs for the entire group were 1.79 diopters (D) and 1.23 D, respectively. The mean PE in each age group was: 3.43 D in Group 1, 2.14 D in Group 2, 1.60 D in Group 3, and 1.33 D in Group 4. The mean PE in eyes with ALs shorter than 20 mm was 2.67 D, and 1.44 D in eyes with an AL of 20 mm or longer. The mean PE in eyes with corneal radii less than 7.3 mm was 2.45 D, and 1.66 D in eyes with corneal radii of 7.3 mm or more. In the age and AL subgroups, the PE differences were statistically significant (P < .05). CONCLUSIONS The PE was larger in the youngest study group, and it decreased gradually with age and in eyes with ALs shorter than 20 mm. The PE has to be considered during BIL IOL power calculation in children.
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Affiliation(s)
- Lyubomyr M Lytvynchuk
- Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Maximilian V Thiele
- Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Werner Schmidt
- Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Birgit Lorenz
- Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Giessen, Germany.
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Lyu J, Zhao P. Intraocular lens implantation in combination with lensectomy and vitrectomy for persistent fetal vasculature. Graefes Arch Clin Exp Ophthalmol 2020; 258:2849-2856. [PMID: 32780257 DOI: 10.1007/s00417-020-04880-9] [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: 04/17/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To present surgical outcomes following intraocular lens (IOL) implantation in combination with lensectomy and vitrectomy for the treatment of persistent fetal vasculature (PFV). METHODS This interventional case series included 19 eyes from 19 patients with unilateral combined PFV. Limbal lensectomy, capsulotomy, anterior vitrectomy, dissection of the retrolental membrane and stalk, and in-the-bag or in-the-sulcus IOL implantation were performed for the treatment of visually significant lenticular opacity with the presence of a retrolental fibrovascular membrane and stalk, in an eye with sufficient capsular support. Postoperative anatomical and visual outcomes were evaluated. RESULTS After 22 to 50 months of follow-up, IOLs were well positioned in 18 (95%) of 19 eyes. Retinal dragging was reversed in all 8 eyes with preexisting peripapillary tractional retinopathy. Major complications occurred in 2 eyes (11%): one eye (5.5%) of vitreous hemorrhage and posterior capsular opacity and one eye (5.5%) of IOL dislocation. Nine (47%) of 19 eyes achieved best-corrected visual acuity (BCVA) above 20/200. Myopic shift after IOL implantation ranged from 0.75 to 4.17 D. Compared with eyes with poorer BCVA, eyes with BCVA above 20/200 had a better preoperative BCVA (mean 20/400 vs. 20/4000, P = 0.004) and were less likely to have preexisting peripapillary tractional retinopathies (11% vs. 70%, P = 0.002). CONCLUSION Primary IOL implantation in combination with lensectomy and vitrectomy is an alternative to treat eyes with combined PFV. Prospects for rehabilitation may be limited by poor preoperative visual function and the presence of tractional retinopathies preoperatively. Postoperative refractive status requires long-term monitoring.
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Affiliation(s)
- Jiao Lyu
- Department of Ophthalmology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, 1665 Kong Jiang Road, Shanghai, 200092, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, 1665 Kong Jiang Road, Shanghai, 200092, China.
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Xia T, Martinez CE, Tsai LM. Update on Intraocular Lens Formulas and Calculations. Asia Pac J Ophthalmol (Phila) 2020; 9:186-193. [PMID: 32501896 PMCID: PMC7299214 DOI: 10.1097/apo.0000000000000293] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/04/2020] [Indexed: 12/13/2022] Open
Abstract
Investigators, scientists, and physicians continue to develop new methods of intraocular lens (IOL) calculation to improve the refractive accuracy after cataract surgery. To gain more accurate prediction of IOL power, vergence lens formulas have incorporated additional biometric variables, such as anterior chamber depth, lens thickness, white-to-white measurement, and even age in some algorithms. Newer formulas diverge from their classic regression and vergence-based predecessors and increasingly utilize techniques such as exact ray-tracing data, more modern regression models, and artificial intelligence. This review provides an update on recent literature comparing the commonly used third- and fourth-generation IOL formulas with newer generation formulas. Refractive outcomes with newer formulas are increasingly more and more accurate, so it is important for ophthalmologists to be aware of the various options for choosing IOL power. Historically, refractive outcomes have been especially unpredictable in patients with unusual biometry, corneal ectasia, a history of refractive surgery, and in pediatric patients. Refractive outcomes in these patient populations are improving. Improved biometry technology is also allowing for improved refractive outcomes and surgery planning convenience with the availability of newer formulas on various biometry platforms. It is crucial for surgeons to understand and utilize the most accurate formulas for their patients to provide the highest quality of care.
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Affiliation(s)
- Tina Xia
- John F Hardesty MD Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis MO
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18
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Chang P, Lin L, Li Z, Wang L, Huang J, Zhao YE. Accuracy of 8 intraocular lens power calculation formulas in pediatric cataract patients. Graefes Arch Clin Exp Ophthalmol 2020; 258:1123-1131. [PMID: 32064543 DOI: 10.1007/s00417-020-04617-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/16/2019] [Accepted: 01/31/2020] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To compare the accuracy of the eight formulas for intraocular lens (IOL) power calculation in pediatric cataract patients. METHODS A retrospective study. A total of 68 eyes (68 patients) that underwent uneventful cataract surgery and posterior chamber IOL implantation in the capsular bag were enrolled. We compared the calculation accuracy of the 8 formulas at 1 month postoperatively and performed subgroup analysis according to age or axial length (AL). RESULTS The mean age at surgery was 34.07 ± 24.60 months and mean AL was 21.12 ± 1.42 mm. The mean prediction errors (PE) of eight formulas for all patients were as follows: SRK II (- 0.66), SRK/T (- 0.44), Holladay 1 (- 0.36), Hoffer Q (- 0.09), Olsen (0.71), Barrett (0.37), Holladay 2 (- 0.70), and Haigis (0.50). There was significant difference among the 8 formulas (p < 0.0001), while no significant difference of absolute PE was found among the 8 formulas in all patients (p = 0.053). Moreover, in patients younger than 2 years old or with AL ≤ 21 mm, SRK/T formula was relatively accurate in 34% and 39% of eyes, respectively. While in patients older than 2 or with AL > 21 mm, Barrett and Haigis formulas were better (58% and 47% for Barrett, 52% and 53% for Haigis). CONCLUSION Overall, in patients younger than 2 years old or with AL ≤ 21 mm, SRK/T formulas were relatively accurate, while Barrett and Haigis formulas were better in patients older than 2 or with AL > 21 mm.
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Affiliation(s)
- Pingjun Chang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou Xueyuan Road, Wenzhou, 325102, Zhejiang, China.,Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
| | - Lei Lin
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou Xueyuan Road, Wenzhou, 325102, Zhejiang, China.,Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
| | - Zhangliang Li
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou Xueyuan Road, Wenzhou, 325102, Zhejiang, China.,Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
| | - Li Wang
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Jinhai Huang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou Xueyuan Road, Wenzhou, 325102, Zhejiang, China.,Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
| | - Yun-E Zhao
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou Xueyuan Road, Wenzhou, 325102, Zhejiang, China. .,Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China.
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Vianna LM, Prescott CR, Ferraz LO. Trifocal toric intra-ocular lens implantation in pediatric traumatic cataract. Am J Ophthalmol Case Rep 2020; 17:100575. [PMID: 31909292 PMCID: PMC6938961 DOI: 10.1016/j.ajoc.2019.100575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose To present the case of a 6-year-old child who presented with a traumatic cataract and was treated with trifocal toric intra-ocular lens implantation. Observations The child's uncorrected distance visual acuity improved from +0.7 logMAR preoperatively to 0.00 logMAR after cataract surgery, with spectacle independence and no reported side effects Conclusions and importance In carefully selected pediatric patients with traumatic cataracts, trifocal toric intra-ocular lenses may offer some benefit over standard monofocal lenses
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Affiliation(s)
- Lucas M.M. Vianna
- State University of Rio de Janeiro, 77 Boulevard 28 de Setembro, Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto da Visão Cabo Frio, 15 Raul Veiga Street, Cabo Frio, Rio de Janeiro, Brazil
- Corresponding author. Instituto da Visão Cabo Frio, 15 Raul Veiga Street, Cabo Frio, Rio de Janeiro, Brazil.
| | | | - Lívio O. Ferraz
- State University of Rio de Janeiro, 77 Boulevard 28 de Setembro, Rio de Janeiro, Rio de Janeiro, Brazil
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20
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Liu ZZ, Long EP, Lin DR, Ye L, Xiang YF, Li WT, Wu XH, Zhao XT, Liu XP, Zhao LQ, Huang XC, Yu TY, Chen H, Chen JJ, Wu MX, Lin HT, Chen WR, Liu YZ. Dynamic profile of ocular refraction in pediatric cataract patients after lens surgeries. Int J Ophthalmol 2019; 12:1839-1847. [PMID: 31850165 DOI: 10.18240/ijo.2019.12.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/18/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To study the change in ocular refraction in patients with pediatric cataracts (PCs) after lens extraction. METHODS A total of 1258 patients who were undergoing cataract extraction with/without intraocular lens (IOL) implantation were recruited during preoperative examinations between Jan 2010 and Oct 2013. Patient ages ranged from 1.5mo to 14y. Follow-ups were conducted at 1wk, 1, and 3mo postoperatively and every 3mo in the first year, then 6mo thereafter. Ocular refraction [evaluated as spherical equivalent (SE)] and yearly myopic shift (YMS) were recorded and statistically analyzed among patients with age at surgery, baseline ocular refraction, gender, postoperative time and laterality (bilateral vs unilateral). RESULTS By Dec 31st 2015, 1172 participants had been followed for more than 2y. The median follow-up period was 3y. The critical factors affecting the ocular refraction of PC patients were baseline ocular refraction, postoperative time for both aphakic and pseudophakic eyes. YMS grew most rapidly in young childhood and early adolescence. CONCLUSION After lens surgeries, ocular refraction in PC patients shows an individual difference of change. Further concerns should be raising to monitor the rapid myopic shift at early adolescence of these patients.
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Affiliation(s)
- Zhen-Zhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Er-Ping Long
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Duo-Ru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Lei Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Yi-Fan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Wang-Ting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Xiao-Hang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Xu-Tu Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Xiao-Ping Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Lan-Qin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Xiu-Cheng Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Tong-Yong Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Hui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Jing-Jing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Ming-Xing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Hao-Tian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Wei-Rong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Yi-Zhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
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Bothun ED, Wilson ME, Vanderveen DK, Plager DA, Freedman SF, Trivedi RH, Traboulsi EI, Anderson JS, Loh AR, Yen KG, Weil NC, Morrison D, Lambert SR. Outcomes of Bilateral Cataracts Removed in Infants 1 to 7 Months of Age Using the Toddler Aphakia and Pseudophakia Treatment Study Registry. Ophthalmology 2019; 127:501-510. [PMID: 31987642 DOI: 10.1016/j.ophtha.2019.10.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate outcomes of bilateral cataract surgery in infants 1 to 7 months of age performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and to compare them with IATS unilateral outcomes. DESIGN Retrospective case series review at 10 IATS sites. PARTICIPANTS The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the IATS. METHODS Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement during IATS enrollment years 2004 through 2010. MAIN OUTCOME MEASURES Visual acuity (VA), strabismus, adverse events (AEs), and reoperations. RESULTS One hundred seventy-eight eyes (96 children) were identified with a median age of 2.5 months (range, 1-7 months) at the time of cataract surgery. Forty-two eyes (24%) received primary IOL implantation. Median VA of the better-seeing eye at final study visit closest to 5 years of age with optotype VA testing was 0.35 logarithm of the minimum angle of resolution (logMAR; optotype equivalent, 20/45; range, 0.00-1.18 logMAR) in both aphakic and pseudophakic children. Corrected VA was excellent (<20/40) in 29% of better-seeing eyes, 15% of worse-seeing eyes. One percent showed poor acuity (≥20/200) in the better-seeing eye, 12% in the worse-seeing eye. Younger age at surgery and smaller (<9.5 mm) corneal diameter at surgery conferred an increased risk for glaucoma or glaucoma suspect designation (younger age: odds ratio [OR], 1.44; P = 0.037; and smaller cornea: OR, 3.95; P = 0.045). Adverse events also were associated with these 2 variables on multivariate analysis (younger age: OR, 1.36; P = 0.023; and smaller cornea: OR, 4.78; P = 0.057). Visual axis opacification was more common in pseudophakic (32%) than aphakic (8%) eyes (P = 0.009). Unplanned intraocular reoperation occurred in 28% of first enrolled eyes (including glaucoma surgery in 10%). CONCLUSIONS Visual acuity after bilateral cataract surgery in infants younger than 7 months is good, despite frequent systemic and ocular comorbidities. Although aphakia management did not affect VA outcome or AE incidence, IOL placement increased the risk of visual axis opacification. Adverse events and glaucoma correlated with a younger age at surgery and glaucoma correlated with the presence of microcornea.
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Affiliation(s)
- Erick D Bothun
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota.
| | - M Edward Wilson
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | | | - David A Plager
- Department of Ophthalmology, Indiana University Medical Center, Indianapolis, Indiana
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Rupal H Trivedi
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Elias I Traboulsi
- Department of Pediatric Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jill S Anderson
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Allison R Loh
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon
| | - Kimberly G Yen
- Departments of Ophthalmology and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Natalie C Weil
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - David Morrison
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott R Lambert
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Departments of Ophthalmology and Pediatrics, Stanford University School of Medicine, Palo Alto, California
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22
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Trivedi RH, Barnwell E, Wolf B, Wilson ME. A Model to Predict Postoperative Axial Length in Children Undergoing Bilateral Cataract Surgery With Primary Intraocular Lens Implantation. Am J Ophthalmol 2019; 206:228-234. [PMID: 31078538 PMCID: PMC7179734 DOI: 10.1016/j.ajo.2019.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To develop a model for predicting postoperative globe axial length (AL) in children undergoing bilateral cataract surgery with primary intraocular lens (IOL) implantation in children older than 2 years. DESIGN Retrospective case series. METHODS Children were included only if AL data were available for both eyes before surgery and at least 1 year after surgery. We analyzed variables that could influence globe axial growth and developed a multivariable generalized estimating equation regression model to predict postoperative AL. RESULTS Sixty-four children were included. The median age at surgery and at follow-up was 5.1 and 12.5 years, respectively. AL measurements were obtained in both eyes during 242 visits. The median AL before and at last follow-up was 22.2 and 23.1 mm, respectively. Beta value for the final model to predict postoperative AL is as below: intercept (1.93), preoperative AL (0.91), age at cataract surgery (-0.07), age at follow-up (0.14), and interaction between age at surgery and age at follow-up (-0.005). Using this model, for a hypothetical patient operated at 2.5 years of age with a 20.5 mm AL would be estimated to have a 22.8 mm AL at 18 years of age. CONCLUSION IOL power selection is a major challenge of pediatric cataract surgery attributable to unpredictable future eye growth. This model theoretically could be used to predict individual future adult size AL for each child undergoing cataract surgery, helping the surgeon to customize the selection of an IOL power at implantation and also to help the parents understand what to expect.
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Affiliation(s)
- Rupal H Trivedi
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Eliza Barnwell
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bethany Wolf
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA
| | - M Edward Wilson
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA
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23
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Bothun ED, Wilson ME, Traboulsi EI, Diehl NN, Plager DA, Vanderveen DK, Freedman SF, Yen KG, Weil NC, Loh AR, Morrison D, Anderson JS, Lambert SR, Lambert S, Hutchinson A, Christiansen S, Bothun E, Wilson E, Traboulsi E, Plager D, Neely D, Vanderveen D, Buckley E, Freedman S, Wallace D, Yen K, Wheeler D, Morrison D. Outcomes of Unilateral Cataracts in Infants and Toddlers 7 to 24 Months of Age. Ophthalmology 2019; 126:1189-1195. [DOI: 10.1016/j.ophtha.2019.03.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/28/2019] [Accepted: 03/08/2019] [Indexed: 01/22/2023] Open
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24
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Bach A, Villegas VM, Gold AS, Shi W, Murray TG. Axial length development in children. Int J Ophthalmol 2019; 12:815-819. [PMID: 31131242 DOI: 10.18240/ijo.2019.05.18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/23/2019] [Indexed: 12/18/2022] Open
Abstract
AIM To study ocular axial lengths in pediatric subjects without intraocular pathology. METHODS An Institutional Review Board-approved consecutive retrospective chart review of axial lengths measured in pediatric subjects who underwent examination under anesthesia due to positive family history of retinoblastoma or other inherited ocular disease. Only subjects without any intraocular pathology in either eye were included. Subjects were stratified into age groups. An axial length model using a logarithmic regression algorithm was calculated. RESULTS Data from 330 eyes of 165 subjects were included in the study. The mean age at the time of examination was 30.62 (SD 18.04)mo. The steepest increase in axial length was present during the first 10mo of life. After 36mo, there was no statistically significant axial length growth. CONCLUSION This study presents the biggest series of pediatric axial lengths in healthy eyes. The axial length model developed with these data may assist in the diagnosis and management of a wide variety of pediatric ophthalmic diseases.
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Affiliation(s)
- Austin Bach
- Larkin Eye Institute, Miami, Florida 33143, USA
| | | | - Aaron S Gold
- Murray Ocular Oncology & Retina, Miami, Florida 33143, USA
| | - Wei Shi
- Bascom Palmer Eye Institute, Miami, Florida 33136, USA
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25
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Valeina S, Heede S, Erts R, Sepetiene S, Skaistkalne E, Radecka L, Vanags J, Laganovska G. Factors influencing myopic shift in children after intraocular lens implantation. Eur J Ophthalmol 2019; 30:933-940. [DOI: 10.1177/1120672119845228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Intraocular lenses have always been a controversial topic in pediatric cataract surgery. In the early 1990s in the post-Soviet states of Eastern Europe, intraocular lenses promised an easier full-time correction and amblyopia treatment. Since 1991, ophthalmologists in Latvia have been implanting intraocular lenses in infants. Amount of the postoperative myopic shift and its influencing factors, analyzed in this article, are important indicators of congenital cataract treatment. Materials and methods: A retrospective chart review off 85 children (137 eyes) who underwent foldable posterior chamber intraocular lens implantation at the Clinical University Hospital in Riga, Latvia, from 1 January 2006 until 31 December 2016, was performed. Depending on the age at surgery, patients were divided into six groups: 1–6, 7–12, 13–24, 25–48, 49–84, and 85–216 months. Results: The largest and more variable myopic shift was found in a group of diffuse/total and nuclear cataract with surgery before the age of 6 months. There was a statistically significant correlation between the acquired best-corrected visual acuity and the amount of myopic shift (rs = 0.33; p < 0.001). Comparing the amount of myopic shift in two groups of different intraocular lens implantation target refraction tactics, we did not find statistically significant differences. Comparing the amount of myopic shift and implanted intraocular lens power, a negative, statistically significant correlation was found. Conclusion: The earlier the cataract extraction surgery and intraocular lens implantation is performed, the larger the myopic shift. The morphological type of cataract, best-corrected visual acuity, secondary glaucoma, and intraocular lens power influence the amount of myopic shift.
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Affiliation(s)
| | - Santa Heede
- University Eye Clinic Eppendorf, Hamburg, Germany
| | - Renars Erts
- Faculty of Medicine, University of Latvia, Riga, Latvia
| | | | | | | | - Juris Vanags
- Stradin’s Clinical University Hospital, Riga, Latvia
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26
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Louison S, Blanc J, Pallot C, Alassane S, Praudel A, Bron AM, Creuzot-Garcher C. Visual outcomes and complications of congenital cataract surgery. J Fr Ophtalmol 2019; 42:368-374. [DOI: 10.1016/j.jfo.2018.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 10/27/2022]
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Mohammadpour M, Shaabani A, Sahraian A, Momenaei B, Tayebi F, Bayat R, Mirshahi R. Updates on managements of pediatric cataract. J Curr Ophthalmol 2018; 31:118-126. [PMID: 31317088 PMCID: PMC6611931 DOI: 10.1016/j.joco.2018.11.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 11/02/2018] [Accepted: 11/14/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose A comprehensive review in congenital cataract management can guide general ophthalmologists in managing such a difficult situation which remains a significant cause of preventable childhood blindness. This review will focus on surgical management, postoperative complications, and intraocular lens (IOL)-related controversies. Methods Electrical records of PubMed, Medline, Google Scholar, and Web of Science from January 1980 to August 2017 were explored using a combination of keywords: "Congenital", "Pediatric", "Childhood", "Cataract", "Lens opacity", "Management", "Surgery", "Complication", "Visual rehabilitation”, and "Lensectomy". A total number of 109 articles were selected for the review process. Results This review article suggests that lens opacity obscuring the red reflex in preverbal children and visual acuity of less than 20/40 is an absolute indication for lens aspiration. For significant lens opacity that leads to a considerable risk of amblyopia, cataract surgery is recommended at 6 weeks of age for unilateral cataract and between 6 and 8 weeks of age for bilateral cases. The recommended approach in operation is lens aspiration via vitrector and posterior capsulotomy and anterior vitrectomy in children younger than six years, and IOL implantation could be considered in patients older than one year. Most articles suggested hydrophobic foldable acrylic posterior chamber intraocular lens (PCIOL) for pediatrics because of lower postoperative inflammation. Regarding the continuous ocular growth and biometric changes in pediatric patients, under correction of IOL power based on the child's age is an acceptable approach. Considering the effects of early and late postoperative complications on the visual outcome, timely detection, and management are of a pivotal importance. In the end, the main parts of post-operation visual rehabilitation are a refractive correction, treatment of concomitant amblyopia, and bifocal correction for children in school age. Conclusions The management of congenital cataracts stands to challenge for most surgeons because of visual development and ocular growth. Children undergoing cataract surgery must be followed lifelong for proper management of early and late postoperative complications. IOL implantation for infants less than 1 year is not recommended, and IOL insertion for children older than 2 years with sufficient capsular support is advised.
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Affiliation(s)
- Mehrdad Mohammadpour
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirreza Shaabani
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Sahraian
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Momenaei
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Tayebi
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Bayat
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mirshahi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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28
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Refractive outcomes of cataract surgery in primary congenital glaucoma. Eye (Lond) 2018; 33:542-548. [PMID: 30382237 DOI: 10.1038/s41433-018-0253-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 07/20/2018] [Accepted: 08/05/2018] [Indexed: 11/08/2022] Open
Abstract
AIM To evaluate refractive outcomes of cataract surgery with intraocular lens (IOL) implantation in operated eyes of primary congenital glaucoma (PCG). DESIGN A retrospective case-control study. METHODS Patients of PCG who developed cataract following trabeculectomy with trabeculotomy were recruited. Preoperative biometry was recorded and refractive outcomes of the patients in terms of spherical equivalent (SE) and prediction error were noted at 3 and at 12 months following surgery. The refractive outcomes were compared with non-glaucomatous eyes of children in similar age group who underwent lens aspiration with IOL implantation (controls). RESULTS The median age of the children with PCG (n = 31) at the time of cataract surgery was 60 months, similar to controls (n = 29); 48 months (p = 0.3). The SE in PCG eyes at 12 months was comparable to controls (p = 0.18). The prediction error (postoperative SE - predicted SE) at 3 months (p = 0.018) and at 12 months (p = 0.03) among PCG eyes was higher and more myopic compared with controls. The range of prediction error at 12 months in PCG eyes was - 8.6 to + 5.8 D (median - 2.0 D), whereas in controls it was - 4.2 to + 6.3 D (median + 0.5 D). For each mmHg intraocular pressure (IOP) increase there was 0.42 mm increase in axial length among PCG eyes and a 0.24 mm increase among controls (p < 0.001). CONCLUSIONS After IOL implantation there was a greater prediction error and a greater myopic shift among PCG eyes. Eyes of children with PCG are more prone to refractive surprises as their axial length changes are more sensitive to IOP fluctuation.
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29
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Effect of smartphone application assisted medical service on follow-up adherence improvement in pediatric cataract patients. Graefes Arch Clin Exp Ophthalmol 2018; 256:1923-1931. [DOI: 10.1007/s00417-018-4080-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022] Open
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30
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Demirkılınç Biler E, Yıldırım Ş, Üretmen Ö, Köse S. Long-term Results in Pediatric Developmental Cataract Surgery with Primary Intraocular Lens Implantation. Turk J Ophthalmol 2018; 48:1-5. [PMID: 29576890 PMCID: PMC5854852 DOI: 10.4274/tjo.80947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 06/07/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the outcomes of pediatric developmental cataract surgery with primary intraocular lens (IOL) implantation. MATERIALS AND METHODS Patients between 2 and 16 years old who underwent cataract surgery with primary IOL implantation were retrospectively evaluated. Age at time of surgery, pre- and postoperative best corrected visual acuities, postoperative ocular complications, and any accompanying ocular pathologies were obtained from the patients' charts. Mean refractive changes and degree of myopic shift were analyzed according to the age groups. Operated eyes were also compared with the fellow eyes in unilateral cases. RESULTS A total of 101 eyes of 65 patients were included. The average age at time of surgery was 76±40 months and the average follow-up period was 44±30 months. Among the 78 eyes that could be assessed for visual acuity improvement, 66 (84.6%) of them showed ≥2 lines of improvement. The difference in the mean refractive change between the 2-5 years old and 8-16 years old age groups was found to be statistically significant. However, the mean refractive change per year was not found to be significant between the same age groups. In unilateral cases, the operated eyes showed a greater myopic change than the fellow eyes, with no statistically significant difference. The most common postoperative complication was visual axis opacity. CONCLUSION Good visual outcomes can be achieved following pediatric cataract surgery with primary IOL implantation. Optic axis opacities were the most common postoperative complications. Overall, refractive changes following surgery are inevitable, and more prominent in younger age groups.
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Affiliation(s)
| | - Şeyda Yıldırım
- Adıyaman University Research and Training Hospital, Department of Ophthalmology, Adıyaman, Turkey
| | - Önder Üretmen
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
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31
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Hussin HM, Markham R. Long-Term Visual Function Outcomes of Congenital Cataract Surgery with Intraocular Lens Implantation in Children under 5 Years of Age. Eur J Ophthalmol 2018; 19:754-61. [DOI: 10.1177/112067210901900512] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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32
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Šimunović M, Paradžik M, Škrabić R, Unić I, Bućan K, Škrabić V. Cataract as Early Ocular Complication in Children and Adolescents with Type 1 Diabetes Mellitus. Int J Endocrinol 2018; 2018:6763586. [PMID: 29755521 PMCID: PMC5883981 DOI: 10.1155/2018/6763586] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/28/2018] [Indexed: 12/19/2022] Open
Abstract
Cataract is a rare manifestation of ocular complication at an early phase of T1DM in the pediatric population. The pathophysiological mechanism of early diabetic cataract has not been fully understood; however, there are many theories about the possible etiology including osmotic damage, polyol pathway, and oxidative stress. The prevalence of early diabetic cataract in the population varies between 0.7 and 3.4% of children and adolescents with T1DM. The occurrence of diabetic cataract in most pediatric patients is the first sign of T1DM or occurs within 6 months of diagnosis of T1DM. Today, there are many experimental therapies for the treatment of diabetic cataract, but cataract surgery continues to be a gold standard in the treatment of diabetic cataract. Since the cataract is the leading cause of visual impairment in patients with T1DM, diabetic cataract requires an initial screening as well as continuous surveillance as a measure of prevention and this should be included in the guidelines of pediatric diabetes societies.
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Affiliation(s)
- Marko Šimunović
- Department of Pediatrics, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Martina Paradžik
- Department of Ophthalmology, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Roko Škrabić
- School of Medicine, University of Split, Šoltanska 2, Split, Croatia
| | - Ivana Unić
- Department of Pediatrics, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Kajo Bućan
- Department of Ophthalmology, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Veselin Škrabić
- Department of Pediatrics, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
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Indaram M, VanderVeen DK. Postoperative Refractive Errors Following Pediatric Cataract Extraction with Intraocular Lens Implantation. Semin Ophthalmol 2017; 33:51-58. [DOI: 10.1080/08820538.2017.1353812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Maanasa Indaram
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Deborah K. VanderVeen
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Advances in technology have made surgery in children safer and faster. The management of pediatric cataract has made rapid progress in the past decade with the availability of safer anesthesia, newer technique's, more predictable intraocular lens (IOL) power calculation, a better understanding of neurobiology, genetics, amblyopia management, improved IOL designs for preventing visual axis opacification, and adjuvant postoperative care. Modern vitrectomy machines with minimally invasive instruments, radiofrequency, diathermy, and plasma blades help immensely in complicated cases. Preoperative evaluation with ultrasound biomicroscopy and optical coherence tomography (OCT) allows better planning of surgical procedure. The future holds good for stem cell research, customized OCT, and Zepto (precision pulse capsulotomy).
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Affiliation(s)
- Sudarshan Kumar Khokhar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All Institute of Medical Sciences, New Delhi, India
| | - Ganesh Pillay
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All Institute of Medical Sciences, New Delhi, India
| | - Esha Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All Institute of Medical Sciences, New Delhi, India
| | - Manish Mahabir
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All Institute of Medical Sciences, New Delhi, India
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Weakley D, Cotsonis G, Wilson ME, Plager DA, Buckley EG, Lambert SR. Anisometropia at Age 5 Years After Unilateral Intraocular Lens Implantation During Infancy in the Infant Aphakia Treatment Study. Am J Ophthalmol 2017; 180:1-7. [PMID: 28526552 DOI: 10.1016/j.ajo.2017.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To report the prevalence of anisometropia at age 5 years after unilateral intraocular lens (IOL) implantation in infants. DESIGN Prospective randomized clinical trial. METHODS Fifty-seven infants in the Infant Aphakia Treatment Study (IATS) with a unilateral cataract were randomized to IOL implantation with an initial targeted postoperative refractive error of either +8 diopters (D) (infants 28 to <48 days of age) or +6 D (infants 48-210 days of age). Anisometropia was calculated at age 5 years. Six patients were excluded from the analyses. RESULTS Median age at cataract surgery was 2.2 months (interquartile range [IQR], 1.2, 3.5 months). The mean age at the age 5 years follow-up visit was 5.0 ± 0.1 years (range, 4.9-5.4 years). The median refractive error at the age 5 years visit of the treated eyes was -2.25 D (IQR -5.13, +0.88 D) and of the fellow eyes +1.50 D (IQR +0.88, +2.25). Median anisometropia was -3.50 D (IQR -8.25, -0.88 D); range -19.63 to +2.75 D. Patients with glaucoma in the treated eye (n = 9) had greater anisometropia (glaucoma, median -8.25 D; IQR -11.38, -5.25 D vs no glaucoma median -2.75; IQR -6.38, -0.75 D; P = .005). CONCLUSIONS The majority of pseudophakic eyes had significant anisometropia at age 5 years. Anisometropia was greater in patients that developed glaucoma. Variability in eye growth and myopic shift continue to make refractive outcomes challenging for IOL implantation during infancy.
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36
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Zhu X, Du Y, He W, Sun T, Zhang Y, Chang R, Zhang K, Lu Y. Clinical Features of Congenital and Developmental Cataract in East China: A Five-year Retrospective Review. Sci Rep 2017; 7:4254. [PMID: 28652574 PMCID: PMC5484708 DOI: 10.1038/s41598-017-04332-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 05/12/2017] [Indexed: 12/19/2022] Open
Abstract
Congenital/developmental cataract is a significant cause of blindness in children worldwide. Full knowledge of clinical features is essential for early diagnosis and proper treatment to prevent irreversible visual impairment. We conducted a retrospective chart review on 520 congenital/developmental cataract cases based on a five-year clinical data from Eye and ENT Hospital of Fudan University, Shanghai, China. Clinical features including age at the surgery, chief complaints, interval between initial identification of cataract-related manifestations and surgery, etc. were summarized. 56.3% of children were bilateral. The age at surgery ranged from 0.25 to 17.4 years, only 9.2% receiving surgery below 1 year. Interval between initial identification of manifestations and surgery ranged from 2 days to 17 years. Concomitant congenital abnormalities were present in 67 patients, with persistent hyperplastic primary vitreous and congenital heart disease as the most frequent ocular and systemic disorders. Strabismus and nystagmus were seen in 20.6% and 11.9% of patients. In bilateral cataract patients with strabismus, axial lengths of esotropia-affected eyes were statistically shorter than exotropia-affected eyes. These findings provide information on characteristics of congenital/developmental cataract in China and may assist in achievement of comprehensive treating strategies in these cases.
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Affiliation(s)
- Xiangjia Zhu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Key Laboratory of Myopia, Ministry of Health, 83 Fenyang Road, Shanghai, 200031, China.,Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Yu Du
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Key Laboratory of Myopia, Ministry of Health, 83 Fenyang Road, Shanghai, 200031, China.,Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Wenwen He
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Key Laboratory of Myopia, Ministry of Health, 83 Fenyang Road, Shanghai, 200031, China.,Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Ting Sun
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, 130 Dong'an Road, 200032, Shanghai, China
| | - Yinglei Zhang
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Key Laboratory of Myopia, Ministry of Health, 83 Fenyang Road, Shanghai, 200031, China.,Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Ruiqi Chang
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Key Laboratory of Myopia, Ministry of Health, 83 Fenyang Road, Shanghai, 200031, China.,Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Keke Zhang
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Key Laboratory of Myopia, Ministry of Health, 83 Fenyang Road, Shanghai, 200031, China.,Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Yi Lu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China. .,Key Laboratory of Myopia, Ministry of Health, 83 Fenyang Road, Shanghai, 200031, China. .,Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China. .,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
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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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Eissa SA. Management of pseudophakic myopic anisometropic amblyopia with piggyback Visian ® implantable collamer lens. Acta Ophthalmol 2017; 95:188-193. [PMID: 27681455 DOI: 10.1111/aos.13203] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/21/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the outcomes of sulcus implantation of the Visian® implantable collamer lens (ICL) to correct pseudophakic myopic anisometropic amblyopia with myopic shift and/or primary refractive overcorrection. METHODS Prospective case series enrolled 14 pseudophakic eyes of 14 patients, 5-9 years old, with history of cataract surgery and primary in the bag-intraocular lenses (IOL) implantation, followed by myopic shift and/or refractive overcorrection and anisometropic amblyopia of variable degrees. All cases had implantation of a piggyback ICL/toric ICL, to correct the myopia/myopic astigmatism. Preoperatively, we evaluated the uncorrected distance visual acuity (UCVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), intraocular pressure (IOP) and endothelial cell density (ECD). We assessed the position and vaulting of the ICLs on slit lamp examination and confirmed by Scheimpflug tomography. Postoperative follow-up was at 1st week and 1, 3, 6, 9, 12, 18 and 24 months. RESULTS Uncorrected distance visual acuity improved in all cases, and CDVA improved in 11 amblyopic eyes (2-4 lines). There was no evidence of interlenticular opacification (ILO) throughout the 2-year follow-up. Two cases were complicated with early postoperative acute elevation of IOP and were controlled with topical beta-blockers. Postoperative acute anterior uveitis occurred in six eyes and controlled by topical steroids. Implantable collamer lens (ICL) vault was measured using Pentacam, with mean value of 470 ± 238 μm. CONCLUSION Sulcus implantation of the secondary piggyback ICL to correct unilateral pseudophakic myopic refractive error in children was safe, efficient, predictable and well tolerated in management of anisometropic amblyopia in all eyes.
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Affiliation(s)
- Sherif A. Eissa
- Faculty of medicine; Kasr Al Ainy; Ophthalmology department; Cairo University; Cairo Egypt
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Weakley DR, Lynn MJ, Dubois L, Cotsonis G, Wilson ME, Buckley EG, Plager DA, Lambert SR. Myopic Shift 5 Years after Intraocular Lens Implantation in the Infant Aphakia Treatment Study. Ophthalmology 2017; 124:822-827. [PMID: 28215452 DOI: 10.1016/j.ophtha.2016.12.040] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/16/2016] [Accepted: 12/16/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To report the myopic shift at 5 years of age after cataract surgery with intraocular lens (IOL) implantation for infants enrolled in the Infant Aphakia Treatment Study (IATS). METHODS Refractions were performed at 1 month and every 3 months postoperatively until age 4 years and then at ages 4.25, 4.5, and 5 years. The change in refraction over time was estimated by linear mixed model analysis. RESULTS Intraocular lens implantation was completed in 56 eyes; 43 were analyzed (median age, 2.4 months; range, 1.0-6.8 months). Exclusions included 11 patients with glaucoma, 1 patient with Stickler syndrome, and 1 patient with an IOL exchange at 8 months postoperatively. The mean rate of change in a myopic direction from 1 month after cataract surgery to age 1.5 years was 0.35 diopters (D)/month (95% confidence interval [CI], 0.29-0.40 D/month); after age 1.5 years, the mean rate of change in a myopic direction was 0.97 D/year (95% CI, 0.66-1.28 D/year). The mean refractive change was 8.97 D (95% CI, 7.25-10.68 D) at age 5 years for children 1 month of age at surgery and 7.22 D (95% CI, 5.54-8.91 D) for children 6 months of age at surgery. The mean refractive error at age 5 years was -2.53 D (95% CI, -4.05 to -1.02). CONCLUSIONS After IOL implantation during infancy, the rate of myopic shift occurs most rapidly during the first 1.5 years of life. Myopic shift varies substantially among patients. If the goal is emmetropia at age 5 years, then the immediate postoperative hypermetropic targets should be +10.5 D at 4 to 6 weeks and +8.50 D from 7 weeks to 6 months. However, even using these targets, it is likely that many children will require additional refractive correction given the high variability of refractive outcomes.
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Affiliation(s)
- David R Weakley
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Michael J Lynn
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lindreth Dubois
- Department of Ophthalmology, School of Medicine, Emory University, Atlanta, Georgia
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - M Edward Wilson
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Edward G Buckley
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - David A Plager
- Department of Ophthalmology, Glick Eye Institute, Indiana University, Indianapolis, Indiana
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
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Validation of Guidelines for Undercorrection of Intraocular Lens Power in Children. Am J Ophthalmol 2017; 174:17-22. [PMID: 27818207 DOI: 10.1016/j.ajo.2016.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Initial undercorrection of intraocular lens (IOL power) is a common practice in children undergoing pediatric cataract surgery. However, the long-term refractive status of these children is largely unknown. The purpose of this study is to analyze the long-term refractive status of these children. DESIGN Retrospective observational study. METHODS We analyzed records of children (<7 years of age) who underwent cataract surgery with a primary IOL implantation and had completed follow-up to ≥7 years of age. Data were collected regarding demographics, etiology of cataract, method of undercorrection, and serial follow-up refractions. Prediction error was defined as refractive error minus emmetropia. The main outcome measure was prediction error at 7 years of age. RESULTS Eighty-four eyes of 56 children (28 unilateral and 28 bilateral cases) met the study criteria. The median age at surgery was 3.3 years (interquartile range 2.7-5 years), and the median follow-up period was 3.75 years. At 7 years of age, the median absolute prediction was 1.5 diopters (interquartile range 0.75-2 diopters). Seven of 84 (8.3%) children achieved emmetropia while an equal proportion were myopic (45%) or hypermetropic (46%). Prediction error (adjusted for using both eyes) at 7 years of age was not significantly different in any group (P > .05). Maximum myopic shift was observed in children <2 years of age. Age at surgery was the only significant factor that influenced prediction error (â = -0.32; P = .001). CONCLUSION This study suggests that children undercorrected using guidelines suggested by Enyedi and associates may achieve an acceptable refractive error at 7 years of age. However, in children <2 years of age, more hypermetropia may be observed. More studies are needed to validate various methods of undercorrection and compare with other guidelines.
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Lambert SR, Cotsonis G, DuBois L, Wilson ME, Plager DA, Buckley EG, McClatchey SK. Comparison of the rate of refractive growth in aphakic eyes versus pseudophakic eyes in the Infant Aphakia Treatment Study. J Cataract Refract Surg 2016; 42:1768-1773. [PMID: 28007108 PMCID: PMC5189691 DOI: 10.1016/j.jcrs.2016.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare the rate of refractive growth (RRG) between aphakic eyes and pseudophakic eyes in the Infant Aphakia Treatment Study (IATS). SETTING Twelve clinical sites across the United States. DESIGN Randomized clinical trial. METHODS Patients randomized to unilateral cataract extraction with contact lens correction versus intraocular lens (IOL) implantation in the IATS had their rate of refractive growth (RRG3) calculated based on the change in refraction from the 1-month postoperative examination to age 5 years. The RRG3 is a logarithmic formula designed to calculate the RRG in children. Two-group t tests were used to compare the mean refractive growth between the contact lens group and IOL group and outcomes based on age at surgery and visual acuity. RESULTS Longitudinal refractive data were studied for 108 of 114 patients enrolled in the IATS (contact lens group, n = 54; IOL group, n = 54). The mean RRG3 was similar in the contact lens group (-18.0 diopter [D] ± 11.0 [SD]) and the IOL group (-19.0 ± 9.0 D) (P = .49). The RRG3 value was not correlated with age at cataract surgery, glaucoma status, or visual outcome in the IOL group. In the aphakia group, only visual outcome was correlated with refractive growth (P = .01). CONCLUSIONS Infants' eyes had a similar rate of refractive growth after unilateral cataract surgery whether or not an IOL was implanted. A worse visual outcome was associated with a higher RRG in aphakic, but not pseudophakic, eyes. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Scott R Lambert
- From the Department of Ophthalmology (Lambert, DuBois) and the School of Medicine and Biostatistics and Bioinformatics (Cotsonis), Rollins School of Public Health, Emory University, Atlanta, Georgia, the Storm Eye Institute (Wilson), Medical University of South Carolina, Charleston, South Carolina, Glick Eye Institute (Plager), Indiana University, Indianapolis, Indiana, the Department of Ophthalmology, (Buckley), Duke University, Durham, North Carolina, the Department of Ophthalmology, Naval Medical Center, San Diego, and Loma Linda University Medical Center (McClatchey), Loma Linda, California, and the Uniformed Services University of Health Sciences (McClatchey), Bethesda, Maryland, USA.
| | - George Cotsonis
- From the Department of Ophthalmology (Lambert, DuBois) and the School of Medicine and Biostatistics and Bioinformatics (Cotsonis), Rollins School of Public Health, Emory University, Atlanta, Georgia, the Storm Eye Institute (Wilson), Medical University of South Carolina, Charleston, South Carolina, Glick Eye Institute (Plager), Indiana University, Indianapolis, Indiana, the Department of Ophthalmology, (Buckley), Duke University, Durham, North Carolina, the Department of Ophthalmology, Naval Medical Center, San Diego, and Loma Linda University Medical Center (McClatchey), Loma Linda, California, and the Uniformed Services University of Health Sciences (McClatchey), Bethesda, Maryland, USA
| | - Lindreth DuBois
- From the Department of Ophthalmology (Lambert, DuBois) and the School of Medicine and Biostatistics and Bioinformatics (Cotsonis), Rollins School of Public Health, Emory University, Atlanta, Georgia, the Storm Eye Institute (Wilson), Medical University of South Carolina, Charleston, South Carolina, Glick Eye Institute (Plager), Indiana University, Indianapolis, Indiana, the Department of Ophthalmology, (Buckley), Duke University, Durham, North Carolina, the Department of Ophthalmology, Naval Medical Center, San Diego, and Loma Linda University Medical Center (McClatchey), Loma Linda, California, and the Uniformed Services University of Health Sciences (McClatchey), Bethesda, Maryland, USA
| | - M Edward Wilson
- From the Department of Ophthalmology (Lambert, DuBois) and the School of Medicine and Biostatistics and Bioinformatics (Cotsonis), Rollins School of Public Health, Emory University, Atlanta, Georgia, the Storm Eye Institute (Wilson), Medical University of South Carolina, Charleston, South Carolina, Glick Eye Institute (Plager), Indiana University, Indianapolis, Indiana, the Department of Ophthalmology, (Buckley), Duke University, Durham, North Carolina, the Department of Ophthalmology, Naval Medical Center, San Diego, and Loma Linda University Medical Center (McClatchey), Loma Linda, California, and the Uniformed Services University of Health Sciences (McClatchey), Bethesda, Maryland, USA
| | - David A Plager
- From the Department of Ophthalmology (Lambert, DuBois) and the School of Medicine and Biostatistics and Bioinformatics (Cotsonis), Rollins School of Public Health, Emory University, Atlanta, Georgia, the Storm Eye Institute (Wilson), Medical University of South Carolina, Charleston, South Carolina, Glick Eye Institute (Plager), Indiana University, Indianapolis, Indiana, the Department of Ophthalmology, (Buckley), Duke University, Durham, North Carolina, the Department of Ophthalmology, Naval Medical Center, San Diego, and Loma Linda University Medical Center (McClatchey), Loma Linda, California, and the Uniformed Services University of Health Sciences (McClatchey), Bethesda, Maryland, USA
| | - Edward G Buckley
- From the Department of Ophthalmology (Lambert, DuBois) and the School of Medicine and Biostatistics and Bioinformatics (Cotsonis), Rollins School of Public Health, Emory University, Atlanta, Georgia, the Storm Eye Institute (Wilson), Medical University of South Carolina, Charleston, South Carolina, Glick Eye Institute (Plager), Indiana University, Indianapolis, Indiana, the Department of Ophthalmology, (Buckley), Duke University, Durham, North Carolina, the Department of Ophthalmology, Naval Medical Center, San Diego, and Loma Linda University Medical Center (McClatchey), Loma Linda, California, and the Uniformed Services University of Health Sciences (McClatchey), Bethesda, Maryland, USA
| | - Scott K McClatchey
- From the Department of Ophthalmology (Lambert, DuBois) and the School of Medicine and Biostatistics and Bioinformatics (Cotsonis), Rollins School of Public Health, Emory University, Atlanta, Georgia, the Storm Eye Institute (Wilson), Medical University of South Carolina, Charleston, South Carolina, Glick Eye Institute (Plager), Indiana University, Indianapolis, Indiana, the Department of Ophthalmology, (Buckley), Duke University, Durham, North Carolina, the Department of Ophthalmology, Naval Medical Center, San Diego, and Loma Linda University Medical Center (McClatchey), Loma Linda, California, and the Uniformed Services University of Health Sciences (McClatchey), Bethesda, Maryland, USA
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Repka MX, Dean TW, Lazar EL, Yen KG, Lenhart PD, Freedman SF, Hug D, Rahmani B, Wang SX, Kraker RT, Wallace DK. Cataract Surgery in Children from Birth to Less than 13 Years of Age: Baseline Characteristics of the Cohort. Ophthalmology 2016; 123:2462-2473. [PMID: 27769584 PMCID: PMC5121052 DOI: 10.1016/j.ophtha.2016.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/01/2016] [Accepted: 09/03/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To describe baseline characteristics, initial postoperative refractive errors, operative complications, and magnitude of the intraocular lens (IOL) prediction error for refractive outcome in children undergoing lensectomy largely in North America. DESIGN Prospective registry study of children from birth to <13 years of age who underwent lensectomy for any reason within 45 days preceding enrollment. PARTICIPANTS Total of 1266 eyes of 994 children; 49% female and 59% white. METHODS Measurement of refractive error, axial length, and complete ophthalmic examination. MAIN OUTCOME MEASURES Eye and systemic associated conditions, IOL style, refractive error, pseudophakic refraction prediction error, operative and perioperative complications. RESULTS Mean age at first eligible lens surgery was 4.2 years; 337 (34%) were <1 year of age. Unilateral surgery was performed in 584 children (59%). Additional ocular abnormalities were noted in 301 eyes (24%). An IOL was placed in 35 of 460 eyes (8%) when surgery was performed before 1 year of age, in 70 of 90 eyes (78%) from 1 to <2 years of age, and in 645 of 716 eyes (90%) from 2 to <13 years of age. The odds of IOL implantation were greater in children ≥2 years of age than in those <2 years of age (odds ratio = 29.1; P < 0.001; 95% confidence interval: 19.6-43.3). Intraoperative complications were reported for 69 eyes (5%), with the most common being unplanned posterior capsule rupture in 14 eyes, 10 of which had an IOL placed. Prediction error of the implanted IOL was <1.00 diopter in 54% of eyes, but >2.00 diopters in 15% of eyes. CONCLUSIONS Lensectomy surgery was performed throughout childhood, with about two-thirds of cases performed after 1 year of age. Initial surgery seemed safe, with a low complication rate. IOL placement was nearly universal in children 2 years of age and older. The immediate postoperative refraction was within 1 diopter of the target for about one-half of eyes.
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Affiliation(s)
| | | | | | - Kimberly G Yen
- Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | | | | | - Denise Hug
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Bahram Rahmani
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Sukhija J, Ram J, Gupta N, Sawhney A, Kaur S. Long-term results after primary intraocular lens implantation in children operated less than 2 years of age for congenital cataract. Indian J Ophthalmol 2016; 62:1132-5. [PMID: 25579356 PMCID: PMC4313492 DOI: 10.4103/0301-4738.149131] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To study the long-term outcome of cataract surgery with primary intraocular lens (IOL) in children <2 years. MATERIALS AND METHODS Retrospective analysis of bilateral cases that were operated before 2 years age for congenital cataract. All underwent primary posterior capsulotomy with anterior vitrectomy and primary IOL implantation. Only those with a follow-up of at least 8 years were evaluated. RESULTS Twenty-six eyes of 13 children with bilateral cataract met the inclusion criteria. Average age at surgery was 14.15 months with a mean follow-up of 102 months. Average preoperative axial length (AL) was 19.93 mm. There was a refractive shift from a mean spherical equivalent of 1.64 D at 2 weeks after surgery to -1.42 D measured at last follow-up. Twenty-four eyes out of 26 (92%) achieved final visual acuity (VA) of 6/18 or more at last follow-up with 19/26 (73%) having acuity of 6/12 or greater. Raised intraocular pressure was documented in one eye only. Average AL recorded at last follow-up was 22.21 mm. CONCLUSION Primary IOL implantation in children <2 years is a safe surgical procedure with excellent long-term results. The myopic shift is well-controlled and final VA achieved is reasonably good.
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Affiliation(s)
| | - Jagat Ram
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Vasavada V, Shah SK, Vasavada VA, Vasavada AR, Trivedi RH, Srivastava S, Vasavada SA. Comparison of IOL power calculation formulae for pediatric eyes. Eye (Lond) 2016; 30:1242-50. [PMID: 27494083 DOI: 10.1038/eye.2016.171] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/05/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo evaluate and compare the accuracy of modern intraocular lens (IOL) power calculation formulae in pediatric eyes and compare prediction error (PE) obtained with manufacturer's vs personalized lens constant.Patients and methodsAn observational case study was conducted in 117 eyes (117 patients) undergoing pediatric cataract surgery with IOL implantation. PE was calculated as predicted refraction minus actual postoperative refraction, and absolute PE as absolute difference independent of the sign, (APE)=predicted refraction minus actual postoperative refraction. This was done for each formula using manufacturer's and personalized lens constant. Further, PE and APE were evaluated according to axial length (AL).ResultsMean age of children was 2.97 years. About 66/117 eyes (56.4%) were below 2 years of age. Using Holladay 2, Holladay 1, Hoffer Q, and SRK/T formulae with manufacturer's lens constant, mean PE was 0.36, 0.41, 0.69, and 0.28 diopter (D), respectively. With personalized lens constant, it was 0.16, 0.15, 0.50, and -0.12 D, respectively. Difference in mean PE between the formulae was statistically significant (P<0.0001). SRK/T and Holladay 2 formulae had the least PE, both with manufacturer's and personalized constant. For eyes with AL<20 mm, SRK/T and Holladay 2 formulae gave the least PE. Personalizing the lens constant led to a decrease in mean PE in all formulae, except the Hoffer Q formula. However, personalizing the lens constant did not significantly improve the APE. At least 21% eyes had an APE of >2 D with all formulae, even with personalized lens constants.ConclusionIn pediatric eyes, SRK/T and the Holladay 2 formulae had the least PE. Personalizing the lens formula constant did reduce the PE significantly for all formulae except Hoffer Q. In extremely short eyes (AL<20 mm), SRK/T and Holladay 2 formulae gave the best PE.
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Affiliation(s)
- V Vasavada
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
| | - S K Shah
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
| | - V A Vasavada
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
| | - A R Vasavada
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
| | - R H Trivedi
- Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
| | - S Srivastava
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
| | - S A Vasavada
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
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Aung YY, McLeod A. Contact lens management of irregular corneas after traumatic aphakia: A pediatric case series. Cont Lens Anterior Eye 2015; 38:382-8. [DOI: 10.1016/j.clae.2015.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 03/11/2015] [Accepted: 03/28/2015] [Indexed: 11/17/2022]
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46
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Magli A, Forte R, Carelli R, Rombetto L, Magli G. Long-Term Outcomes of Primary Intraocular Lens Implantation for Unilateral Congenital Cataract. Semin Ophthalmol 2015; 31:548-53. [DOI: 10.3109/08820538.2015.1009556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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47
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Nagamoto T, Oshika T, Fujikado T, Ishibashi T, Sato M, Kondo M, Kurosaka D, Azuma N. Clinical characteristics of congenital and developmental cataract undergoing surgical treatment. Jpn J Ophthalmol 2015; 59:148-56. [PMID: 25608682 DOI: 10.1007/s10384-015-0370-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/19/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the clinical characteristics of congenital/developmental cataract undergoing surgery. METHODS A mail questionnaire was sent to 49 facilities engaged in surgical treatment of congenital cataracts, and data on preoperative clinical features were collected. RESULTS Twenty nine facilities reported on 864 eyes of 521 patients with congenital/infantile cataract, ranging in age at initial visit from 0 to 18.8 years (2.6 ± 3.3 years, mean ± standard deviation). Among the patients, 65.8 % had bilateral cataracts and 34.2 % were unilaterally affected. Family history was found for 22.4 % of cases, of which 98.1 % were bilateral. Family history was positive for 33.1 % of bilateral and 1.3 % of unilateral cases. The most common main complaint was white pupil for 35.7 % of bilateral cases and 32.7 % for unilateral cases. Concomitant systemic abnormalities were more frequently associated with bilateral cases (31.6 %) than with unilateral cases (16.7 %). Associated ocular diseases, such as strabismus, persistent fetal vasculature, and posterior lenticonus, were more frequently seen among unilateral cases whereas nystagmus was more common among bilateral cases. CONCLUSIONS Among congenital/developmental cataracts, the ratio of bilateral and unilateral cases was approximately 2:1. Almost all patients with a family history of congenital cataract were bilateral. Initial visits to a physician were rather late, 2.6 years from birth; this should be improved.
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Affiliation(s)
- Toshiyuki Nagamoto
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
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Plager DA, Lynn MJ, Buckley EG, Wilson ME, Lambert SR, Plager DA, Lynn MJ, Buckley EG, Wilson ME, Lambert SR, Lambert SR, DuBois L, Lambert SR, Buckley EG, Plager DA, Wilson ME, Lynn M, DuBois L, Drews-Botsch C, Hartmann EE, Everett DF, Russell B, Ward M, Hardy R, Birch E, Cheng K, Hertle R, Kollman C, Yeargin-Allsopp M, McDowell C, Everett DF, Lynn M, Bridgman B, Celano M, Cleveland J, Cotsonis G, Drews-Botsch C, Freret N, Lu L, Swanson S, Tutu-Gxashe T, Busettini C, Hayley S, Felius J, Beck A, Everett DF, Hartmann EE, Carrigan AK, Edwards C, Wilson ME, Bozic M, Vanderveen DK, Mansfield TA, Miller KB, Christiansen SP, Bothun ED, Holleschau A, Jedlicka J, Winters P, Lang J, Traboulsi EI, Crowe S, Cimino HH, Yen KG, Castanes M, Sanchez A, York S, Lambert SR, Hutchinson AK, Dubois L, Robb R, Shainberg MJ, Wheeler DT, Stout AU, Rauch P, Beaudet K, Berg P, Buckley EG, Freedman SF, Duncan L, Phillips B, Petrowski JT, Morrison D, Owings S, Biernacki R, Franklin C, Plager DA, Neely DE, Whitaker M, Bates D, Donaldson D, Kruger S, Tibi C, Vega S, Weakley DR, Stager DR, Felius J, Dias C, Sager DL, Brantley T, Orge F. Complications in the first 5 years following cataract surgery in infants with and without intraocular lens implantation in the Infant Aphakia Treatment Study. Am J Ophthalmol 2014; 158:892-8. [PMID: 25077835 DOI: 10.1016/j.ajo.2014.07.031] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 07/17/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens (IOL) implantation. DESIGN Prospective randomized clinical trial. METHODS A total of 114 infants were enrolled in the Infant Aphakia Treatment Study, a randomized, multi-center (12) clinical trial comparing the treatment of unilateral aphakia in patients under 7 months of age with a primary IOL implant or contact lens. The rate, character, and severity of intraoperative complications, adverse events, and additional intraocular surgeries during the first 5 postoperative years in the 2 groups were examined. RESULTS There were more patients with intraoperative complications (28% vs 11%, P = .031), adverse events (81% vs 56%, P = .008), and more additional intraocular surgeries (72% vs 16%, P < .0001) in the IOL group than in the contact lens group. However, the number of patients with adverse events in the contact lens group increased (15 to 24) in postoperative years 2-5 compared to the first postoperative year, while it decreased (44 to 14) in years 2-5 compared to the first postoperative year in the IOL group. If only one half of the patients in the contact lens (aphakic) group eventually undergo secondary IOL implantation, the number of additional intraocular surgeries in the 2 groups will be approximately equal. CONCLUSION The increased rate of complications, adverse events, and additional intraocular surgeries associated with IOL implantation in infants <7 months of age militates toward leaving babies aphakic if it is considered likely that the family will be successful with contact lens correction.
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Matsuo T. Intraocular lens implantation in unilateral congenital cataract with minimal levels of persistent fetal vasculature in the first 18 months of life. SPRINGERPLUS 2014; 3:361. [PMID: 25061553 PMCID: PMC4108679 DOI: 10.1186/2193-1801-3-361] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 07/08/2014] [Indexed: 11/25/2022]
Abstract
Purpose To describe the incidence of unilateral congenital cataract associated with minimal (ultrasonically undetectable) levels of persistent fetal vasculature in the first 18 months of the life and to report surgical methods for intraocular lens implantation, using 25-gauge vitrectomy system. Methods Retrospective review was made on 16 consecutive patients with bilateral or unilateral congenital cataract in the first 18 months of the life who underwent surgery at Okayama University Hospital after the introduction of the 25-gauge vitrectomy system from October 2005 to March 2013. As the standard of care at this hospital in the study period, intraocular lenses were not implanted in children with bilateral cataract while intraocular lenses were implanted in those with unilateral cataract. Results Ten children with bilateral cataract underwent lensectomy in both eyes with a 25-gauge vitreous cutter under irrigation with a 25-gauge infusion cannula, inserted from two side ports at the corneal limbus. Six children with unilateral cataract underwent intraocular lens implantation and posterior capsulotomy after lens aspiration from limbal side ports. No patient showed vitreous abnormalities on ultrasound examinations before the surgery. At the surgery, all 10 children with bilateral cataract showed no additional abnormalities. In contrast, 3 children with unilateral cataract at the age younger than 12 months showed white fibrous tissue in the anterior vitreous integrated with the posterior lens capsule while the other 3 children with unilateral cataract at the age from 12 to 18 months did not have vitreous abnormalities. The fibrous tissue was cut together in the process of posterior capsulotomy from a 25-gauge trocar inserted at 1.5 mm posterior from the corneal limbus. Conclusions Unilateral congenital cataract in the first 12 months of the life has a high incidence for the association with anterior type of persistent fetal vasculature which could not be detected by preoperative ultrasound examinations. Intraocular lens implantation was technically feasible in unilateral cataract with or without minimal levels of persistent fetal vasculature in the first 18 months of the life.
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Affiliation(s)
- Toshihiko Matsuo
- Department of Ophthalmology, Okayama University Medical School and Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 2-5-1 Shikata-cho, Okayama City, 700-8558 Japan
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