Refractive outcomes of cataract surgery in primary congenital glaucoma

Relationship Between Postoperative Intraocular Lens Shift and Postoperative Refraction Change in Cataract Surgery Using Three Different Types of Intraocular Lenses

Introduction

Understanding the relationship between postoperative intraocular lens (IOL) shift and refractive change is crucial for the accuracy of predicted postoperative refraction (PPR). We assessed the relationships between different IOL fixation methods, haptic designs, and several metrics.

Methods

Single-center, open-label study which included 69 eyes. We preoperatively measured the anterior chamber depth (ACD), lens thickness (LT), axial length (AL), and PPR. AcrySof IQ (n = 27) and FineVision (n = 24) were fixed in the bag, and FEMTIS (n = 18) was fixed in capsulorhexis. At 1 day, 1 week, and 1 month postoperatively, we checked the IOL position and refraction and compared the IOL shift, refraction change, and the margin of error of the predicted PPR (PR-PPR difference). We also analyzed the correlation between postoperative and preoperative variables.

Results

FEMTIS showed the highest stability in terms of IOL shift and refraction. The in-the-bag-fixated IOLs showed a significant forward shift between 1 day and 1 week postoperatively. There were significant differences in the PR-PPR difference between the IOLs. ACD and AL showed significant positive correlations, and LT showed a significant negative correlation with IOL shift and change in PR between 1 day and 1 week, but not between 1 week and 1 month postoperatively.

Conclusion

The relationship between postoperative IOL shift and refraction change varied according to IOLs with different haptic types. Capsulorhexis fixation may be more stable than in-the-bag fixation. Furthermore, preoperative ACD, LT, and AL may be useful factors to predict IOL shift, change in PR, and to a lesser extent the degree of the margin of error in clinical practice. Our findings may improve the accuracy of PPR and refractive outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40123-021-00390-x.

Scheimpflug Imaging in Operated Primary Congenital Glaucoma

PURPOSE

To report the corneal tomographic characteristics of eyes that had surgery for controlled primary congenital glaucoma (PCG) and to compare it with an age-matched group of normal children.

METHODS

The study was conducted on 44 (24 right) eyes of 27 children (18 boys) who had surgery for PCG and 60 (31 right) eyes of 32 age-matched control children (9 boys). Children with PCG had a thorough ophthalmic examination and the demographic and medical and surgical history was retrieved from the patients' clinical chart records. After clinical examination, the study participants underwent Scheimpflug imaging using the Pentacam (Oculus Optikgeräte GmbH).

RESULTS

Both study and control children were approximately 9 years of age at the time of the study (P = .39). The eyes with PCG had a spherical equivalent mean ± standard deviation of -4.70 ± 3.50 diopters (D). Eyes with PCG demonstrated a cylinder of -2.80 ± 2.10 D, flatter corneas than control eyes (P = .0002 and .0012 for flat and steep keratometry, respectively), and statistically significantly higher astigmatism (P = .011) and thinner corneas, both at pupil center (P < .001) and thinnest location (P < .001). There was a statistically significant negative correlation between the postoperative axial length (at the time of the scan) and each of the Scheimpflug parameters flat keratometry (P = .002), steep keratometry (P = .003), pachymetry at pupil center (P = .01), and pachymetry at thinnest location (P = .009).

CONCLUSIONS

The eyes of patients with PCG have thinner, flatter, and more astigmatic corneas than the eyes of age-matched control children. [J Pediatr Ophthalmol Strabismus. 2021;58(4):218-223.].

Lens in Primary Congenital Glaucoma Eyes Treated by Combined Angle and Filtering Surgery

PURPOSE

To report on the changes in the natural crystalline lens in primary congenital glaucoma (PCG) eyes that had undergone previous combined angle-filtering surgery with antimetabolites.

SETTINGS

The pediatric ophthalmology unit of the ophthalmology department of Alexandria Main University Hospital.

DESIGN

A retrospective chart review.

METHODS

A retrospective chart review of patients presenting with and operated (by combined angle-filtering surgery with antimetabolites) for PCG in the period from 2005 to 2018. Any lens pathology was noted as well as the management and the outcome.

RESULTS

The records of 422 children (613 eyes) were reviewed. Lens pathology was noted in 54 (8.8%) eyes. Abnormalities in lens clarity (cataract) were detected in 31 (56%) eyes, and abnormalities in lens position (subluxation) were detected in 24 (44%) eyes. Management options included observation (in 28 eyes), lensectomy for aphakia (in 14 eyes), lensectomy with in the bag intraocular lens (IOL) implantation (in 11 eyes), and lensectomy with iris-fixated IOL (in 1 eye). Elevation of intraocular pressure (IOP) occurred in only 4 eyes (of 26 operated eyes, 15.3%) after lens extraction.

CONCLUSIONS

Changes in the natural crystalline lens clarity and/or position occurred in 8.8% (54 of 613) of PCG eyes operated by combined angle-filtering surgery with antimetabolites. Lens extraction was a relatively safe procedure with only 15% (4 of 26) of eyes suffering an elevation of IOP after lens extraction.

[Prediction of postoperative visual acuity in cataract patients with idiopathic macular epiretinal membrane by hand-held retinal optometer and optical coherence tomography]

OBJECTIVE

To investigate the value of hand-held retinal optometer and optical coherence tomography (OCT) in predicting postoperative visual acuity in patients with age-related cataract and idiopathic macular epiretinal membrane.

METHODS

We retrospectively analyzed the data of patients undergoing phacoemulsification combined with intraocular lens implantation for age-related cataract in our hospital from January, 2019 to April, 2020.Preoperative examination detected idiopathic macular epiretinal membrane in 45 of the patients (52 eyes) with lens opacity grade C2N2P1 according to LOCSⅡ lens opacity classification criteria.Based on the thickness of the macular fovea, the eyes were divided into group A (9 eyes) with macular thickness < 300 μm by OCT examination, group B (25 eyes) with macular thickness of 300 to 400 μm, and group C (18 eyes) with macular thickness >400 μm.The best corrected visual acuity and retinal visual acuity before operation and the best corrected visual acuity on the first day and at 3 months after the surgery were compared among the 3 groups.The consistency between the preoperative retinal vision and the best corrected vision at 3 months after the surgery was analyzed.

RESULTS

The best corrected visual acuity at one day and 3 months after the surgery differed significantly from that before the surgery in all the 3 groups (P < 0.05).The best corrected visual acuity recovered to 0.3-0.5 in most of the patients in the 3 groups. Thirty-one (91.18%) of the patients with a macular thickness less than 400 μm had a visual acuity≥0.3 after cataract surgery, as compared with only 14 patients (77.78%) among those with a macular thickness >400 μm.There was a positive linear correlation between preoperative retinal visual acuity and best corrected visual acuity at 3 months after the surgery (r=0.830, P < 0.05).

CONCLUSIONS

For patients with cataract and idiopathic macular epiretinal membrane, phacoemulsification combined with intraocular lens implantation can improve postoperative vision.Hand-held retinal optometer can accurately assess postoperative vision in patients with stage C2N2P1 cataract.Patients with a macular thickness >400 μm caused by idiopathic macular epiretinal membrane are likely to have poor postoperative visual outcomes.