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Sabr M, Semidey VA, Rubio-Caso MJ, Aljuhani Jnr R, Sesma G. Incidence and Risk Factors for Retinal Detachment Following Pediatric Cataract Surgery. Clin Ophthalmol 2024; 18:1623-1636. [PMID: 38855013 PMCID: PMC11162630 DOI: 10.2147/opth.s464005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
Background Retinal detachment is a major postsurgical threat in pediatric cataract surgery; however, the effect of axial length remains unclear. This study aimed to assess the relationship between axial length and detachment risk in vulnerable patients. Methods This retrospective cohort study analyzed 132 eyes of 84 pediatric cataract surgery patients aged <20 years old. Axial length was measured preoperatively, and the incidence of retinal detachment was recorded over a median follow-up of 4 years. Logistic regression analysis was used to examine the axial length-detachment relationship. Results Twenty eyes had postoperative retinal detachments. The median axial length was longer in the detachment group (23.6 mm) than in the non-detachment group (21.6 mm). Eyes with axial length ≤23.4 mm had 0.55-fold decreased odds of detachment compared to longer eyes. Preexisting myopia and glaucoma confer heightened risk. Approximately half of the patients retained some detachment risk eight years postoperatively. Conclusion Shorter eyes (axial length ≤23.4 mm) appear to be protected against pediatric retinal detachment after cataract surgery, whereas myopia, glaucoma, and axial elongation > 23.4 mm elevate the postoperative risk. Understanding these anatomical risk profiles requires surgical planning and follow-up care of children undergoing lensectomy.
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Affiliation(s)
- Mawaddah Sabr
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Valmore A Semidey
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Marcos J Rubio-Caso
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Gorka Sesma
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Schmidt DC, Bach-Holm D, Kessel L. Long-term visual outcomes and ocular complications in children with Marner's hereditary cataracts operated in the period 1940-2021. Acta Ophthalmol 2024. [PMID: 38828897 DOI: 10.1111/aos.16729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE To investigate visual development and long-term complications after cataract surgery in childhood. METHODS This cross-sectional study included patients from a family with Marner's hereditary cataracts who had cataract surgery before 18 years of age. The study was conducted from 1 January 2022 until 31 December 2022. The patients contributed to their medical files and participated in an updated ophthalmologic examination. RESULTS We included 52 patients (101 eyes, 34 females). The median age at cataract surgery was 7 years (IQR: 5-10) and the age at examination was 40 years (IQR: 21-54). Primary and secondary intraocular lens implantation had been performed in 47.5% (25 patients, 48 eyes) and 16.8% (10 patients, 17 eyes). Visual acuity was ≤0.3 logMAR in 77% (78 eyes), and <0.5 logMAR in 8% (8 eyes). Glaucoma was present in 17% (9 patients, 12 eyes), ocular hypertension in 6% (3 patients, 4 eyes), and 10% (5 patients, 5 eyes) had prior retinal detachment. Mild visual field loss (2 < mean defect (MD) ≤ 6 dB) was found in 62% (63 eyes) and moderate to advanced visual field loss (MD > 6 dB) in 24% (24 eyes). Thirty-five patients (67%) held a driver's licence, and three were not allowed to drive due to low visual function. All patients were employed. CONCLUSION After cataract surgery in childhood, many patients achieve normal visual acuity, but mild visual field loss is common. Long-term follow-up is important due to the high risk of glaucoma.
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Affiliation(s)
- Diana Chabané Schmidt
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Daniella Bach-Holm
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Nucci P, Lembo A, Caputo R, Dellavalle A, Serafino M, Schiavetti I, Pichi F. Efficacy and safety of intraoperative use of tropicamide 0.02%/phenylephrine0.31%/lidocaine1% intracameral combination during pediatric cataract surgery. Int Ophthalmol 2022; 43:989-995. [PMID: 36053475 DOI: 10.1007/s10792-022-02501-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To demonstrate the safety and efficacy of the intracameral use of tropicamide 0.02%/phenylephrine 0.31%/lidocaine 1% in pediatric cataract surgery, a combination widely used in adult patients but still off-label in children. METHODS Design: two-center, prospective, observational study. SETTING San Giuseppe Hospital, Milan and Meyer Children's Hospital, Florence. STUDY POPULATION children from 0 to 4 years of age undergoing cataract surgery with or without intraocular IOL implantation, in the absence of clinically significant systemic conditions, history of ocular surgery, concurrent ocular medication, hypersensitivity to any of the substances and post-traumatic cataracts. During the surgery, patients received the combination drug after the primary access to the anterior chamber. Efficacy was evaluated by achieving an adequate mydriasis in order to perform capsulorhexis, while safety was assessed by recording vital signs (heart rate, blood pressure, respiratory rate, temperature) pre- and post-administration of the substance. RESULTS This study included 53 surgical procedures of 36 patients: 41 eyes were left aphakic, while 12 eyes received primary IOL implantation. The pupil size was adequate to safely perform capsulorhexis in 52 procedures of 53. The difference in pupil enlargement was significant (6.0 ± 1.14 mm, P = < 0.001). There were no notable changes in vital parameters. CONCLUSIONS The administration of intracameral tropicamide 0.02%/phenylephrine 0.31%/lidocaine 1% in pediatric cataract surgery is effective for obtaining an adequate mydriasis without any vital parameters changes throughout the procedure.
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Affiliation(s)
- Paolo Nucci
- Department of Clinical Sciences and Community Health, University Eye Clinic, San Giuseppe Hospital-Multimedica, University of Milan, Via San Vittore 12, 20123, Milan, Italy
| | - Andrea Lembo
- Department of Clinical Sciences and Community Health, University Eye Clinic, San Giuseppe Hospital-Multimedica, University of Milan, Via San Vittore 12, 20123, Milan, Italy.
| | - Roberto Caputo
- Department of Pediatric Ophthalmology, Anna Meyer Children's University Hospital, Florence, Italy
| | - Andrea Dellavalle
- Department of Clinical Sciences and Community Health, University Eye Clinic, San Giuseppe Hospital-Multimedica, University of Milan, Via San Vittore 12, 20123, Milan, Italy
| | - Massimiliano Serafino
- Department of Neuroscience, Unit of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
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Microperipheral Iridectomy for Troublesome Posterior Synechiolysis in Secondary Intraocular Lens Implantation. J Ophthalmol 2021; 2021:6634871. [PMID: 33680507 PMCID: PMC7929652 DOI: 10.1155/2021/6634871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/14/2020] [Accepted: 01/13/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To introduce an effective method for separating extensive posterior synechiae and those located under or adjacent to surgical incisions. Methods Pediatric patients who had been subjected to cataract surgery and developed troublesome posterior synechiae requiring secondary intraocular lens (IOL) implantation were recruited. All patients underwent microperipheral iridectomy at the 12 o'clock position. Then, an ophthalmic viscosurgical device was injected into the posterior chamber through the iris fistula to mechanically separate the posterior synechiae, using scissors to cut robust posterior synechiae if necessary. The results of posterior synechiolysis and the position of the implanted IOL were analyzed. Results Sixteen patients (median age, 51.56 months; range, 28–80 months) were included. The scope of posterior synechia in clock was 4.42 (range, 1–10). All troublesome posterior synechiae were successfully separated using the microperipheral iridectomy method, and all patients underwent IOL implantation in the ciliary sulcus. There was one case of peripheral iridectomy-related early intraoperative bleeding; no bleeding was observed at the end of surgery. Conclusions Microperipheral iridectomy is a useful method for the management of troublesome posterior synechiae during secondary IOL implantation in pediatric patients, which makes secondary IOL implantation an easier and safer method in some challenging cases.
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Agarkar S, Gokhale VV, Raman R, Bhende M, Swaminathan G, Jain M. Incidence, Risk Factors, and Outcomes of Retinal Detachment after Pediatric Cataract Surgery. Ophthalmology 2018; 125:36-42. [DOI: 10.1016/j.ophtha.2017.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/18/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022] Open
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Advances in the management of the surgical complications for congenital cataract. Front Med 2012; 6:360-5. [PMID: 23224414 DOI: 10.1007/s11684-012-0235-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022]
Abstract
The greatest concern in children with cataracts is irreversible visual loss. The timing of congenital cataract surgery is critical for the visual rehabilitation. Cataract surgery in children remains complex and challenging. The incidence of complications during or after operation is higher in children than adults. Some complications could be avoided by meticulous attention to surgical technique and postoperative care, and others were caused by more exuberant inflammatory response associated with surgery on an immature eye or the intrinsic eyes abnormalities. Utilizing of advanced techniques and timely applying topical corticosteroids and cycloplegic agents can reduce the occurrence of visual axis opacification. Operation on children with strabismus or nystagmus, and applying occlusion therapy on amblyopic eyes can balance the visual inputs to the two eyes. Diagnosis of glaucoma following congenital cataract surgery requires lifelong surveillance and continuous assessment of the problem. So cataract surgeries in children are not the end of journey, but one step on the long road to visual rehabilitation. This paper describes recent evidence from the literature regarding the advance of management after congenital cataract surgery.
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Churchill A, Graw J. Clinical and experimental advances in congenital and paediatric cataracts. Philos Trans R Soc Lond B Biol Sci 2011; 366:1234-49. [PMID: 21402583 DOI: 10.1098/rstb.2010.0227] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cataracts (opacities of the lens) are frequent in the elderly, but rare in paediatric practice. Congenital cataracts (in industrialized countries) are mainly caused by mutations affecting lens development. Much of our knowledge about the underlying mechanisms of cataractogenesis has come from the genetic analysis of affected families: there are contributions from genes coding for transcription factors (such as FoxE3, Maf, Pitx3) and structural proteins such as crystallins or connexins. In addition, there are contributions from enzymes affecting sugar pathways (particularly the galactose pathway) and from a quite unexpected area: axon guidance molecules like ephrins and their receptors. Cataractous mouse lenses can be identified easily by visual inspection, and a remarkable number of mutant lines have now been characterized. Generally, most of the mouse mutants show a similar phenotype to their human counterparts; however, there are some remarkable differences. It should be noted that many mutations affect genes that are expressed not only in the lens, but also in tissues and organs outside the eye. There is increasing evidence for pleiotropic effects of these genes, and increasing consideration that cataracts may act as early and readily detectable biomarkers for a number of systemic syndromes.
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Abdelmoaty SMA, Behbehani AH. The outcome of congenital cataract surgery in Kuwait. Saudi J Ophthalmol 2011; 25:295-9. [PMID: 23960940 DOI: 10.1016/j.sjopt.2011.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 01/02/2011] [Accepted: 01/07/2011] [Indexed: 10/18/2022] Open
Abstract
AIM Congenital cataract is the most common cause of treatable blindness in children and the outcome of congenital cataract surgery has not been studied in Kuwait, so the purpose of this study is to evaluate the visual outcome and the postoperative complications. METHODS Medical records of children who underwent congenital cataract surgery between September 2000 and December 2008 at Al-Bahar Eye Center, Ministry of Health of Kuwait were retrospectively reviewed. In 100 eyes that fill the inclusion criteria visual acuity and postoperative complications were recorded. The mean follow up was 3.9 ± 1.7 years with range from 3 to 6 years. RESULTS The mean age of congenital/developmental cataract surgery is 8.9 ± 8.7 months for bilateral cases and it was 5.75 ± 4.61 months for unilateral cases. The mean final postoperative BCVA in unilateral cases was 1.0 (20/200) log MAR unit and it was 0.3 (20/40) log MAR unit for the bilateral cases. Four percent of the cases developed postoperative glaucoma and 2% of them developed significant opacification of the posterior capsule. CONCLUSION Our findings provide evidence of recent improvement over time in the visual prognosis in bilateral, and to a lesser degree, unilateral cataract, in children in Kuwait.
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Wang NK, Chen TL, Lai CC, Kuo YH, Chao AN, Wu WC, Chen KJ, Hwang YS, Chen YP, Liu L. Clinical characteristics and surgical outcomes of pediatric retinal detachments with lens disorders. J Pediatr Ophthalmol Strabismus 2009; 46:160-7. [PMID: 19496497 DOI: 10.3928/01913913-20090505-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the clinical characteristics and outcomes of eyes with retinal detachments with lens disorders and compare them to eyes with retinal detachments without lens disorders. METHODS A retrospective chart review of 42 eyes of 37 children who had retinal detachments with lens disorders was performed. Eyes were compared based on epidemiological data, characteristics of retinal detachment, and anatomical and functional surgical outcomes and were then compared to 254 eyes with retinal detachment without lens disorders. RESULTS In eyes with lens disorders, the retina was reattached after the first operation in 13 (31%) eyes and at the end of the intervention in 22 (52%) eyes. Surgical and visual outcomes appeared to be slightly better in the subluxation and dislocation group compared with cataract and aphakia or pseudophakia groups. In eyes without lens disorders, the retina was reattached in 202 (80%) eyes after the first intervention and in 228 (90%) eyes at the end of the intervention. CONCLUSION Pediatric retinal detachment with a lens disorder is associated with unsatisfactory surgical and visual outcomes compared to those without lens disorders. Primary internal and external approaches are suggested in children with complicated retinal detachment with lens disorders.
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Affiliation(s)
- Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkuo, Taoyuan, Taiwan
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Fan DSP, Yip WWK, Yu CBO, Rao SK, Lam DSC. Updates on the Surgical Management of Paediatric Cataract with Primary Intraocular Lens Implantation. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n8p564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
With the advent of modern surgical techniques, paediatric cataract has become much more manageable. Intraocular lens (IOL) implantation is the standard of care for patients over the age of 2 years. The use of IOL in young infants is still controversial. In addition, there are still unresolved issues, such as the minimum age at which IOL can be safely implanted, IOL power selection and IOL power calculation. The current trends in the management of the above challenges are discussed. Although numerous reports on the prevention and management of posterior capsule opacification have been published, there are ongoing intensive debates and research. Long-term postoperative complications like glaucoma and rhegmatogenous retinal detachment are problems that cannot be overemphasised and these issues are also reviewed.
Key words: Congenital cataract, Intraocular lens, Posterior capsule opacification
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Affiliation(s)
| | - Wilson WK Yip
- The Chinese University of Hong Kong, Kowloon, Hong Kong
| | | | | | - Dennis SC Lam
- The Chinese University of Hong Kong, Kowloon, Hong Kong
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