1
|
Ma Z, Zhu S. Rare micropupil secondary to congenital cataract surgery favoring the development of the affected eye: a case report. BMC Ophthalmol 2024; 24:258. [PMID: 38877448 PMCID: PMC11179215 DOI: 10.1186/s12886-024-03507-5] [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: 12/22/2023] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Congenital microcoria has been extensively reported and usually leads to visual dysfunction or blindness. However, micropupil development secondary to cataract surgery has never been reported. Here, we describe a rare case of micropupil development in infancy that occurred secondary to combined cataract extraction and intraocular lens implantation for treatment of congenital cataract. When the patient reached adulthood, the affected eye not only gained good vision but also showed better ocular development and refractive status than the fellow eye. CASE PRESENTATION A 17-year-old boy presented to our outpatient clinic with decreased vision in his left eye related to congenital cataract surgery at 6 months of age. The affected eye had exhibited a pinhole pupil since the third month postoperatively. The condition had been managed with observation and regular monocular occlusion treatment. Upon presentation to our clinic, the best-corrected visual acuity (BCVA) in his fellow eye was 0.0 logMAR(20/20) with a refraction of - 5.75 diopters cylinder/-2.25 diopters sphere, and the BCVA in his affected eye was 0.5 logMAR(20/40) with a refraction of 0.00 diopters. Ophthalmic examination of the affected eye revealed a pinhole pupil (approximately 0.5 mm) with high light reflex sensitivity but no response to pupil-dilating drugs. The patient underwent pupilloplasty of the affected eye under corneal surface anesthesia. Postoperative examination revealed better ocular development in the affected eye than in the fellow eye (axial length: 24.21 vs. 27.02 mm, respectively) as well as better refractive status in the affected eye (BCVA of 0.0 logMAR(20/20) with a refraction of - 2.23 diopters cylinder/-3.00 diopters sphere vs. 0logMAR(20/20) with a refraction of -5.75 diopters cylinder/-2.25 diopters sphere). CONCLUSIONS We have reported a rare case of micropupil development secondary to congenital cataract surgery, which is an uncommon complication, especially in children. However, unlike congenital microcoria, the secondary pinhole pupil may have reduced imaging haze and halos, possibly favoring the development of the affected eye. This case provides further insight into the treatment of congenital cataract.
Collapse
Affiliation(s)
- Zicheng Ma
- Department of Ophthalmology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Siquan Zhu
- Department of Ophthalmology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Liu S, Lian Z, Young C, Ng K, Zhang X, Zheng D, Jin G. Postoperative longitudinal refractive changes in children younger than 8 years with ectopia lentis and Marfan syndrome. J Cataract Refract Surg 2024; 50:134-139. [PMID: 37753933 DOI: 10.1097/j.jcrs.0000000000001326] [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: 05/27/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To evaluate the postoperative longitudinal refractive changes in children younger than 8 years with ectopia lentis and Marfan syndrome (MFS). SETTING Zhongshan ophthalmic center, Guangzhou, China. DESIGN Retrospective cohort study. METHODS Medical data of patients diagnosed with ectopia lentis and MFS that underwent surgery younger than 8 years were collected. Refractive errors and ocular biometric parameters were collected preoperatively and at each follow-up visit. Patients were stratified into groups according to age at surgery, and only the eye operated on first was selected. Multivariate analysis was performed to determine the association between refractive shift and potential risk factors. RESULTS In total, 54 eyes of 54 patients were enrolled. The median age at surgery was 6.21 years (interquartile range [IQR], 5.25 to 6.85), and the median follow-up was 2.0 years (IQR, 1.2 to 2.8 years). At age 8 years, patients demonstrated a median myopic shift ranged from -1.75 diopters (D) (IQR, -2.75 to -1.00 D) for the 4-year-old group to -0.13 D (IQR, -0.50 to -0.06 D) for the 7-year-old group. Multivariate analysis showed that greater myopic shift was associated with younger age at surgery ( P = .004), male sex ( P = .026), and shorter preoperative axis length ( P = .005). CONCLUSIONS A tendency toward increasing postoperative myopic was demonstrated in children with ectopia lentis and MFS, with the greatest myopic shift in the younger age groups. If the goal is to reach emmetropia by age 8 years, the immediate postoperative hypermetropic targets should be 1.75 D for age 4 years, 1 D for age 5 years, 0.5 D for age 6 years, and 0 to 0.25 D for age 7 years.
Collapse
Affiliation(s)
- Siyuan Liu
- From the 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 (Liu, Lian, Ng, Zhang, Zheng, Jin); Albany Medical College, Albany, New York (Young)
| | | | | | | | | | | | | |
Collapse
|
4
|
Zedan R, Farag CS, Gouda J, Awadein A, Elhilali H, Hassanein DH. Outcome of intraocular lens exchange for the management of myopic shift in pseudophakic children. Eur J Ophthalmol 2023:11206721231218299. [PMID: 38055956 DOI: 10.1177/11206721231218299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
PURPOSE To evaluate the visual outcome of intraocular lens (IOL) exchange for the management of myopic shift in pseudophakic children. METHODS The medical records of children who underwent IOL exchange for myopic shift were examined. The preoperative data, operative details and the postoperative outcome were analyzed. RESULTS Twenty-one eyes (16 patients) were identified. Mean age at cataract extraction was 20 ± 26 months (range, 2-84 months). Twelve patients (6 unilateral, 6 bilateral) had primary IOL implantation. Mean age at IOL exchange was 7.3 ± 3.2 years. Mean spherical equivalent (SE) at IOL exchange was -14 ± 5 D (range, -7 to -21 D): Mean SE at IOL exchange was -13.64 ± 4.99 D, -12 ± 1.53 D, and -15.5 ± 4.7 D in unilaterally pseudophakic cases (8 patients), in the eye that underwent unilateral IOL exchange (3 patients) in bilaterally pseudophakic cases, and in bilateral IOL exchange cases (5 patients), respectively. Mean axial length at IOL exchange was 24 ± 1.3 mm (range, 23 to 27 mm). Following IOL exchange, mean SE was reduced to -2 ± 1.8 D (range, -4 to +2.5 D). An average of three logMAR line improvement in the best-corrected visual acuity was observed in 12/16 eyes of patients for whom pre- and post-exchange visual acuity were available, while visual acuity remained unchanged in 4 eyes. Mean logMAR visual acuity improvement was 0.35 and 0.49 in unilateral and bilateral pseudophakic cases, respectively. CONCLUSIONS IOL exchange is a safe procedure that should be considered to improve visual rehabilitation in pseudophakic patients with myopic shift.
Collapse
Affiliation(s)
- Rasha Zedan
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Christina S Farag
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Jylan Gouda
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Awadein
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hala Elhilali
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina H Hassanein
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Menezes Filho C, Messias A, Antunes-Foschini R. Strabismus development after pediatric cataract surgery associated with age at surgery, intraocular lens implantation, and visual acuity outcome. Strabismus 2023; 31:139-144. [PMID: 37407591 DOI: 10.1080/09273972.2023.2231038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
PURPOSE Approximately half of the children operated on for cataracts develop strabismus. We determined what factors predict its development. METHODS In a retrospective, cross-sectional study, children who underwent cataract surgery before age 5 between 2010 and 2017 in a tertiary center in Brazil were identified from medical records. Subsequently, patients were invited for an ophthalmological examination to assess visual acuity, refraction, and strabismus (constant or intermittent heterotropy of any magnitude). In addition, age at surgery, cataract laterality, intraocular lens implantation, surgical complications, nystagmus, anisometropia, and elapsed time between surgery and the present examination were assessed using logistic regression. RESULTS Surgery was performed in 74 eyes of 46 patients (21 males). The median age at surgery was 6.4 (3.7-29.6) months, and the interval between surgery and this examination was 32.5 (18.0-53.0) months. Strabismus was present in 33 (72%) patients, 35% had esotropia and 33% exotropia. One patient had strabismus surgery before the examination. Age at surgery (OR 0.95; p-value .018), IOL implantation (OR 0.08; p-value .027), and current visual acuity on the worse eye (OR 1.16; p-value .036) were associated with strabismus. CONCLUSIONS Strabismus development after pediatric cataract surgery is associated with age at surgery, intraocular lens implantation, and visual-acuity outcomes of the worse eye.
Collapse
Affiliation(s)
- Celso Menezes Filho
- Ribeirão Preto Medical School, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo
| | - Andre Messias
- Ribeirão Preto Medical School, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo
| | - Rosalia Antunes-Foschini
- Ribeirão Preto Medical School, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo
| |
Collapse
|
7
|
Reply: Optic Capture Without Anterior Vitrectomy in Pediatric Cataract Surgery. Am J Ophthalmol 2023:S0002-9394(23)00080-6. [PMID: 36870590 DOI: 10.1016/j.ajo.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 03/06/2023]
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Asif MI, Raj N, Kalra N, Yadav MA, Bafna RK, Sinha R. Premium intraocular lenses in children. Eur J Ophthalmol 2022:11206721221126301. [PMID: 36124376 DOI: 10.1177/11206721221126301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Multifocal and toric intraocular lenses (IOLs) or the so-called premium IOLs are currently widely used in adult patients as a one-step refractive solution following cataract surgery. However, the decision to implant a premium IOL in a pediatric patient involves multiple factors affecting the child's visual development and is associated with several dilemmas and surgical challenges. The purpose of this review is to summarize these factors and analyse the influence of each of them on the visual outcomes following premium IOL implantation. A review of literature was conducted using the relevant keywords from various databases until 31st January 2022. All pertinent studies with multifocal or toric IOL implantation in children were reviewed, and relevant articles were studied in detail for age, IOL power calculation, visual outcomes (refractive outcomes, contrast sensitivity and stereopsis) and complications such as dysphotic phenomena and others. A total of 17 relevant studies (10 case series/interventional studies and 7 case reports) on the subject were included. All studies showed a favourable refractive outcome; however, the data available was significantly less. Studies with earlier models of multifocal IOLs showed a higher incidence of IOL decentration and posterior capsule opacification; however, more recent studies with newer IOL models showed much better safety profiles. Toric IOLs showed promising results in all the studies evaluated. Premium IOLs have shown promising results in the pediatric age group. However, their long-term outcomes specifically concerning refractive shift, capsular contraction and role in the management of amblyopia needs to be explored further.
Collapse
Affiliation(s)
- Mohamed Ibrahime Asif
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Nimmy Raj
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Kalra
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Mrinalini Anand Yadav
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Kumar Bafna
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, 28730All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
11
|
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.
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Zhao QH, Zhao YE. Commentary review: challenges of intraocular lens implantation for congenital cataract infants. Int J Ophthalmol 2021; 14:923-930. [PMID: 34150549 DOI: 10.18240/ijo.2021.06.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/14/2021] [Indexed: 11/23/2022] Open
Abstract
As an indispensable part of congenital cataract surgery, intraocular lens (IOL) implantation in infantile patients has long-term positive impacts on visual rehabilitation, as well as postoperative complications inevitably. Timing of IOL implantation in infantile congenital cataract patients is not simply a point-in-time but a personalized decision that comprehensively takes age at surgery, risks of postoperative complications, and economic condition of family in consideration, and combines with choosing suitable IOL type and power. For infants with well-developed eyeballs and good systemic conditions, IOL implantation at six months of age or older is safe and effective. Otherwise, secondary IOL implantation may be a safer choice.
Collapse
Affiliation(s)
- Qi-Hui Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yun-E Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| |
Collapse
|
16
|
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.
Collapse
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
| | | | | |
Collapse
|
17
|
Zhu X, He W, Du Y, Kraus CL, Xu Q, Sun T, Yu J, Lu Y. Presence of Posterior Staphyloma in Congenital Cataract Children. Curr Eye Res 2019; 44:1319-1324. [PMID: 31246115 DOI: 10.1080/02713683.2019.1637437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose: To investigate the prevalence of posterior staphyloma (PS) in congenital cataract children and its role in predicting postoperative axial elongation.Materials and Methods: Preoperative prevalence of PS in 520 congenital cataract patients was reviewed and compared with that of the healthy eyes of 300 unilateral traumatic cataract children after 1:1 propensity score matching. Then, 32 pseudophakic children with preoperative PS and 48 age-matched pseudophakic controls without preoperative PS were followed up after the surgery, to compare their axial growth rates and refractive changes.Results: Congenital cataract was significantly associated with the presence of PS (OR: 14.88, P = .009) after propensity score matching. Even in congenital cataract eyes with axial length <26 mm, 5% were identified with PS on B-scan: ≤22 mm: 3%, 22-24 mm: 5% and 24-26 mm: 13%. Eyes with preoperative PS exhibited faster postoperative axial growth than those without, especially in bilateral cases or in children undergoing surgery before 8 years old (≤4 years: 0.53 ± 0.33 vs 0.30 ± 0.21 mm/y P = .028; 4-8 years: 0.37 ± 0.26 vs 0.23 ± 0.15 mm/y P = .044). Myopic shift after surgery was also more significant in children with preoperative PS than in those without (-1.10 ± 0.50 vs -0.60 ± 0.47D/y, P < .001).Conclusions: Congenital cataract is a risk factor for PS. Preoperative PS in pediatric cataract eyes may be an indicator of excessive postoperative axial elongation, especially in bilateral cases or in cases undergoing cataract surgery at a younger age. Our findings may also promote better clinical decision-making in intraocular lens power selection for pediatric population.
Collapse
Affiliation(s)
- Xiangjia Zhu
- Department of Ophthalmology, Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wenwen He
- Department of Ophthalmology, Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yu Du
- Department of Ophthalmology, Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Courtney L Kraus
- Pediatric Ophthalmology and Adult Strabismus Krieger Children's Eye Center, Wilmer Eye Institute, Wilmer, TX, USA
| | - Qingguo Xu
- School of Pharmacy, Virginia Commenwealth University, Richmond, VA, USA
| | - Ting Sun
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Jia Yu
- Department of Ophthalmology, Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yi Lu
- Department of Ophthalmology, Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| |
Collapse
|
18
|
Khokhar SK, Tomar A, Pillay G, Agarwal E. Biometric changes in Indian pediatric cataract and postoperative refractive status. Indian J Ophthalmol 2019; 67:1068-1072. [PMID: 31238413 PMCID: PMC6611230 DOI: 10.4103/ijo.ijo_1327_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To prospectively evaluate the biometric changes in Indian pediatric cataract and postoperative refractive status. Methods: A total of 147 patients were recruited into three groups: age <6 months, age between 7 months and 18 months, and age between 19 and 60 months and prospectively observed for 6 months. Exclusion criteria were preterm birth, microphthalmia, microcornea, megalocornea, uveitis, glaucoma, and traumatic or complicated cataract. Axial length and keratometry, the primary outcome measures, were taken preoperatively under general anesthesia before surgery. These children were followed up for 6 months to look for refractive and biometric changes. T-test and linear regression with the logarithm of independent variables were done. Results: All unilateral cataractous eyes (n = 25) and randomly selected bilateral cases (n = 122) were included in the analysis, for a total of 147 eyes. Mean age was 17.163 ± 13.024 months; axial length growth was 0.21, 0.18, 0.06 mm/month, and keratometry decline was 0.083, 0.035, 0.001 D/month in age groups 0–6, 7–18, and 19–60 months, respectively. The visual acuity improved in log MAR from 1.020 to 0.745 at 6 months postoperatively. There was statistically significant (Spearman's correlation coefficient = –0.575, P < 0.001) between age and postoperative refraction. There were no intraocular lens (IOL)-related complications seen in the immediate postoperative period. Peripheral opacification was seen in 102 eyes and central opacification in 1 eye at a 6-month follow-up. Conclusion: Indian eyes have a lower rate of axial length growth and keratometry change in comparison with western eyes implying smaller undercorrection in emmetropic IOL power for Indian pediatric eyes to achieve a moderate amount of hyperopia.
Collapse
Affiliation(s)
- Sudarshan Kumar Khokhar
- Unit of Lens, Refractive and Pediatric Cataract, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ankit Tomar
- Unit of Lens, Refractive and Pediatric Cataract, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ganesh Pillay
- Unit of Pediatric Ophthalmology, ASG Eye Hospital, Arera Colony, Bhopal, Madhya Pradesh, India
| | - Esha Agarwal
- Unit of Lens, Refractive and Pediatric Cataract, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| |
Collapse
|
19
|
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.
Collapse
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
| | | |
Collapse
|
20
|
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.
Collapse
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
| | | |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
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.
Collapse
|
23
|
Kletke SN, Mireskandari K, Ali A. Update on Pediatric Cataract Surgery and the Delphi Panel Paper. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0183-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
24
|
Park J, Lee YG, Kim KY, Kim BY. Predicting Factor of Visual Outcome in Unilateral Idiopathic Cataract Surgery in Patients Aged 3 to 10 Years. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:273-280. [PMID: 30091305 PMCID: PMC6085184 DOI: 10.3341/kjo.2017.0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/25/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose To report the surgical results of unilateral pediatric cataracts from uncertain causes in relatively older children and to identify factors related to better visual outcomes. Methods We retrospectively evaluated the medical records of 39 patients who underwent surgery between the ages of 3 and 10 years for unilateral pediatric cataracts of no known cause. All patients underwent primary intraocular lens implantation and postoperative amblyopia treatment. A postoperative final visual acuity better than 20 / 30 was considered to be a good visual outcome. Results The mean age of patients was 6.0 ± 1.8 years at the time of surgery. The mean preoperative visual acuity was 1.07 ± 0.71 logarithm of the minimum angle of resolution (range, 0.15 to 3.00), while the mean final postoperative visual acuity was 0.47 ± 0.54 logarithm of the minimum angle of resolution (range, 0.00 to 2.00). Of 39 patients, 18 (46.2%) achieved a good visual outcome. Only the preoperative visual acuity maintained a significant association with a good visual outcome according to our multivariate analysis (p = 0.040). A preoperative visual acuity of 20 / 100 or better was found to increase the chance of achieving a good visual outcome by 13.79-fold (95% confidence interval, 1.13 to 167.58). Conclusions The visual outcome of unilateral pediatric cataract surgery for cataracts with no specific cause identified in patients after three years of age could be satisfactory, especially with a preoperative visual acuity of 20 / 100 or better.
Collapse
Affiliation(s)
| | - Youn Gon Lee
- Department of Cornea and Refractive Surgery, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Kook Young Kim
- Department of Cornea and Refractive Surgery, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Byoung Yeop Kim
- Department of Cornea and Refractive Surgery, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea.
| |
Collapse
|
25
|
Yangzes S, Kaur S, Gupta PC, Sharma M, Jinagal J, Singh J, Ram J. Intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life. Eur J Ophthalmol 2018; 29:304-308. [PMID: 30060694 DOI: 10.1177/1120672118790193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To describe the outcome of phacoaspiration with intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life. METHODS A retrospective chart review of children with visually significant unilateral congenital cataract presenting in the first 4 years of life was done. Children with a minimum postsurgical follow-up of 1 year were included. Outcome measures were mean spherical equivalent, visual axis clarity, visual acuity and complications till the last follow-up. RESULTS Ninety-three children met the inclusion criteria. The mean age of surgery was 13.23 ± 11.89 months and the mean follow-up period was 24.37 ± 17.35 months. Nearly 40% of children presented during their first year of life. No difference was noted between the subgroups in terms of age ( p = 0.310), sex ( p = 0.475) or laterality ( p = 0.349). Surgical membranectomy was performed in 22 eyes (23.6%) after an average period of 4.85 ± 2.58 months after surgery. One eye underwent piggy back intraocular lens and four eyes underwent intraocular lens exchange after a mean duration of 50 months (range 40-60 months). The mean visual acuity was 0.79 ± 0.11 (log MAR chart). A total of 60.7% of these children ( n = 31) achieved best corrected visual acuity or 20/80 or better. CONCLUSION The results of our study suggest that primary intraocular lens implantation in children with unilateral congenital cataract gives good structural and functional results. Besides a meticulous surgery, visual outcome is affected by the time of presentation and postoperative compliance to amblyopia therapy.
Collapse
Affiliation(s)
- Sonam Yangzes
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savleen Kaur
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul Chawla Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Sharma
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitender Jinagal
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaspreet Singh
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
26
|
Valera Cornejo DA, Flores Boza A. Relationship between preoperative axial length and myopic shift over 3 years after congenital cataract surgery with primary intraocular lens implantation at the National Institute of Ophthalmology of Peru, 2007-2011. Clin Ophthalmol 2018; 12:395-399. [PMID: 29503527 PMCID: PMC5826293 DOI: 10.2147/opth.s152560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective To determine the relationship between the preoperative axial length and the myopic shift over 3 years after congenital cataract surgery with primary intraocular lens implantation and other related factors. Methods In this retrospective cohort study, the axial length was measured and assigned into 2 groups (>21.5 mm and ≤21.5 mm), visual axis obscuration, laterality of cataract, age of surgery and follow-up time were assessed and compared to the myopic shift. Results The mean myopic shift was 3.6 (standard deviation [SD]: 2.3) diopters (D) in all patients; 3.2 (3.3) and 3.9 (3.2) D for each group respectively (p=0.359). In unilateral cataracts the mean myopic shift was 6.3 D and in bilateral cases was 3.0 D (p=0.001). In bilateral cataracts, the shift was 2.6 D (SD: 2.0) and 3.4 D (SD: 1.8), respectively (p=0.098). Conclusion There was no relationship between the initial axial length and the myopic shift in all patients. Unilateral cataracts had a greater myopic shift over 3 years.
Collapse
Affiliation(s)
| | - Abel Flores Boza
- Pediatric Ophthalmology Department, National Institute of Ophthalmology of Peru, Lima, Peru
| |
Collapse
|
27
|
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.
Collapse
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
| | | |
Collapse
|
28
|
Chougule P, Murat S, Mohamed A, Kekunnaya R. Follow-up patterns and associated risk factors after paediatric cataract surgery: observation over a 5-year period. Br J Ophthalmol 2018; 102:1550-1555. [DOI: 10.1136/bjophthalmol-2017-311294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/13/2018] [Accepted: 01/19/2018] [Indexed: 11/04/2022]
Abstract
PurposeTo study the pattern of compliance to follow-up of children less than 5 years of age undergoing surgery for congenital and developmental cataract over a period of 5 years.MethodsIt is a retrospective study of children less than 5 years of age undergoing cataract surgery between January and December 2010 for congenital or developmental cataract and followed up until 31 December 2015. Age, sex, distance from hospital and urban or rural habitat, delay in presentation, socioeconomic status, laterality, morphology and type of cataract, implantation of intraocular lens and interventions done were noted. Compliance to follow-up at postoperative 1 week, 1 month, 3 months, 6 months, 1 year and then once a year until 5 years were recorded.Results169 patients were included in the study. The median follow-up was 22 months. Median age at surgery was 10 months and had a negative correlation with total follow-up. Male-to-female ratio was 1.82. Logarithmic curve of follow-up was noticed with 85%, 61%, 55%, 52%, 39% and 28% patients attending 1 month, 3 months, 6 months, 1 year, 3 years and 5 years of follow-up, respectively. Low socioeconomic group had poor follow-up compared with higher socioeconomic group (P=0.009), but the curve of follow-up was similar in both groups; multiple interventions group had better follow-up (P<0.0001).ConclusionCurve of loss to follow-up is logarithmic in children undergoing paediatric cataract surgery. Age at surgery and low economic status are the most important factors associated with poor follow-up.
Collapse
|
29
|
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]
|
30
|
Abstract
Pediatric cataract is a leading cause of childhood blindness. Untreated cataracts in children lead to tremendous social, economical, and emotional burden to the child, family, and society. Blindness related to pediatric cataract can be treated with early identification and appropriate management. Most cases are diagnosed on routine screening whereas some may be diagnosed after the parents have noticed leukocoria or strabismus. Etiology of pediatric cataract is varied and diagnosis of specific etiology aids in prognostication and effective management. Pediatric cataract surgery has evolved over years, and with improving knowledge of myopic shift and axial length growth, outcomes of these patients have become more predictable. Favorable outcomes depend not only on effective surgery, but also on meticulous postoperative care and visual rehabilitation. Hence, it is the combined effort of parents, surgeons, anesthesiologists, pediatricians, and optometrists that can make all the difference.
Collapse
Affiliation(s)
| | - Ganesh Pillay
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Chirakshi Dhull
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Esha Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Manish Mahabir
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Pulak Aggarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| |
Collapse
|
31
|
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
| |
Collapse
|
32
|
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.
Collapse
|
33
|
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.
Collapse
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
| | | |
Collapse
|
34
|
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.
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
Benchmarks for outcome indicators in pediatric cataract surgery. Eye (Lond) 2016; 31:417-421. [PMID: 27813517 DOI: 10.1038/eye.2016.240] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/15/2016] [Indexed: 12/28/2022] Open
Abstract
PurposeThe purpose of this study was to establish benchmarks for outcome indicators that may help ascertain the quality of pediatric cataract surgery with primary intraocular lens (IOL) implantation.Patients and methodsA retrospective chart review of patients older than 2 years undergoing cataract surgery with primary IOL implantation, by multiple surgeons in a tertiary-care center, from November 2005 to February 2016 was conducted. Patients with ocular comorbidities that would affect the outcomes were excluded. The outcome measures chosen were as follows: (1) final best corrected Snellen visual acuity (BCVA) in patients who had bilateral cataract surgery analyzed at the last clinic visit; (2) prediction error (PE)=expected refraction-actual refraction. Mean PE and mean absolute PE were assessed 1 month postoperatively, irrespective of age or laterality.ResultsMean age at surgery was 8.3±4.6 years and mean follow-up duration was 3.7±2.7 years. The results of outcome measures were as follows: (1) BCVA was 20/40 or better in 96% (n=124 eyes, mean patient age: 8.3±4.6 years). Remaining five eyes had amblyopia with two eyes having BCVA worse than 20/100 that did not respond to amblyopia treatment. (2) Mean PE was 0.3±1.1 D and mean absolute PE was 0.9±0.7 D. PE was within ±0.5 D in 43.0%, ±1.0 D in 66%, and ±2.0 D in 95% (n=235 eyes).ConclusionGood visual acuity after cataract surgery should be expected for children with bilateral cataracts, setting a high benchmark similar to that recommended in adult cataract surgery. Prediction error is greater in pediatric eyes than in adult eyes, setting a lower benchmark. This study establishes benchmark for outcome indicators in pediatric patients older than 2 years undergoing cataract surgery with primary IOL implantation.
Collapse
|
37
|
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.
Collapse
Affiliation(s)
| | - Jagat Ram
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | |
Collapse
|
38
|
Changing refractive outcomes with increasing astigmatism at longer-term follow-up for infant cataract surgery. Eye (Lond) 2016; 30:1195-8. [PMID: 27419841 DOI: 10.1038/eye.2016.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/07/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo present longer-term refractive and ocular health outcomes for patients who had primary intraocular lens (IOL) insertion following infant cataract surgery.Patients and methodsA retrospective review of all infant cataract cases at a tertiary children's hospital between 2003 and 2006 was conducted. Surgery was performed before 12 months of age. IOL power was calculated using the SRK/T formula targeting hyperopia based on the child's age; children under 3 months were targeted at +9.0 D, between 3 and 6 months at +6.0 D, and between 6 and 12 months at +3.0 D. Locally weighted scatterplot smoothing and mixed models were used.ResultsA total of 12 eyes from 9 children were included (4 bilateral and 5 unilateral). Spherical equivalent refraction decreased dramatically in the first 2 years of life, with milder changes from age 2 to 4 years and minimal changes thereafter. Cylinder increased until age 5 years at ∼0.57 dioptres/year (95% confidence intervals 0.27-0.87 D, P<0.001). Lens reproliferation was the commonest complication (58%). All children eventually developed strabismus.ConclusionEarly and frequent refraction is critical in the first 2 years of life to try and compensate for the rapid changes encountered in the growing eye. Astigmatism may be another important consequence to manage.
Collapse
|
39
|
Intraocular lens exchange for high myopia in pseudophakic children. Eye (Lond) 2016; 30:1199-203. [PMID: 27419831 DOI: 10.1038/eye.2016.152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/21/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeThe purpose of this study was to examine the preoperative factors and postoperative outcomes following intraocular lens (IOL) exchange for high myopia in pseudophakic children.MethodsThe medical records of all patients undergoing IOL exchange for high myopia were retrospectively reviewed.ResultsA total of 15 eyes were identified that had undergone an IOL exchange for myopic shift. Average age of cataract extraction (CE) was 5.4 months. In all, 10/15 had a unilateral cataract. IOL exchange usually occurred at an average of 6 years following cataract surgery. The average spherical equivalent (SE) of the refractive error at that time was -9.6 D. Following IOL exchange, SE was -1.3 D. A two-line reduction in best-corrected visual acuity was observed in 1/13 of our patients for whom pre- and post-exchange data were available. The average axial length (AL) of the eye undergoing the IOL exchange was 24.0 mm, average AL in the non-operative eye was 22.1 mm. On average, the operative eyes grew 4.4 mm and the non-operative eyes 3.02 mm. No adverse events were seen in the operative eyes.ConclusionYounger age at the time of CE creates a greater likelihood of AL elongation and predisposes a child to myopic shift. IOL exchange should be considered an option to reduce anisometropia and associated aniseikonia to improve visual outcomes. Successful visual rehabilitation and predictable post-exchange refractions were seen with our patients.
Collapse
|
40
|
Joshaghani M, Soleimani M, Foroutan A, Yaseri M. Visual Outcomes and Complications of Piggyback Intraocular Lens Implantation Compared to Aphakia for Infantile Cataract. Middle East Afr J Ophthalmol 2016; 22:495-501. [PMID: 26692724 PMCID: PMC4660539 DOI: 10.4103/0974-9233.164610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: To evaluate the long-term visual outcomes and complications of the piggyback intraocular lens (IOL) implantation compared to aphakia for infantile cataract. Patients and Methods: In a comparative study from 1998 to 2007, piggyback IOL implantation (piggyback IOL group) was performed for 14 infants (23 eyes) with infantile cataract and 20 infants (32 eyes) who were aphakic (aphakia group) after infantile cataract surgery. Data were collected on logMAR visual acuity, and postoperative complications over a mean follow-up time of 6.2 ± 1.7 years and 5.8 ± 1.7 years. Results: The mean age at surgery was 7.5 ± 0.6 months and 6.0 ± 3.3 months for the piggyback and the aphakic group respectively (P > 0.05). At the last follow-up visit, visual acuity was 0.85 ± 0.73 (median = 0.70, interquartile range = 0.3–1.32) in the piggyback IOL group and 0.89 ± 0.56 (median = 0.86, interquartile range = 0.50–1.24) in the aphakic group (P > 0.05). There was a positive relationship between age and visual outcomes in the aphakic group (r = 0.4, P = 0.04) but not in the piggyback IOL group (P = 0.48). There was no significant difference between the mean myopic shift in the piggyback IOL group (∑5.28 ± 1.06 D) and the aphakic group (∑5.10 ± 1.02 D) (P > 0.05). The incidence of reoperation due to complications in piggyback IOL group was higher than aphakic group (%48 vs. %16, respectively, P ≤ 0.01). However, in patients older than 6 months, this risk was not significantly different compared to the aphakic group. Conclusions: Although piggyback IOL implantation for infantile cataract is optically acceptable as a treatment option, there is no significant difference in visual outcomes compared to aphakia. The incidence in reoperation due to complications in patients aged 6 months or younger is higher than those treated with aphakia.
Collapse
Affiliation(s)
| | | | | | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
41
|
Abouzeid H, Moetteli L, Munier FL. New-generation multifocal intraocular lens for pediatric cataract. ACTA ACUST UNITED AC 2013; 230:100-7. [PMID: 23880970 DOI: 10.1159/000351653] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/08/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To evaluate multifocal intraocular lens (MIOL) implantation in children. METHODS This is a retrospective study evaluating refractive, visual and safety results of MIOL in pediatric cataract surgery. Average follow-up was 25.73 ± 10.5 months. Surgery included 12 o'clock clear corneal incision, anterior capsulorhexis, lens material aspiration and MIOL implantation (SN6AD3; Alcon). RESULTS We included 34 cataract eyes of 26 pediatric patients aged 2-15 years, of which 14 (54%) were unilateral. Best near visual acuity (BNVA) and best distance visual acuity (BDVA) improved significantly in 100% of eyes (p = 0.0001). BDVA was above 0.8 in 31.25% (5/16) of bilateral cases. Significant stereopsis improvement was observed postoperatively in bilateral cases only (p = 0.01). CONCLUSION MIOL implantation is a safe alternative to monofocal pseudophakia for pediatric cataract with a very low complication rate. Significant BNVA, BDVA and stereopsis improvement can be achieved, particularly in bilateral cases. MESSAGE This study shows significant BDVA, BNVA and stereopsis improvement, especially in bilateral cases, after MIOL implantation for pediatric cataracts.
Collapse
|
42
|
Schulze Schwering M, Msukwa G, Spitzer MS, Kalua K. [Pediatric cataract surgery in Malawi]. Ophthalmologe 2013; 111:348-53. [PMID: 23765373 DOI: 10.1007/s00347-013-2872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the postoperative refractive status after pediatric cataract surgery with age-determined intraocular lens (IOL) implantation in children (age 0-8 years) in Malawi. MATERIALS AND METHODS Hospital-based retrospective study from January to June 2011 analyzing age, sex, origin, type of cataract surgery, IOL power and postoperative refractive status. In the absence of biometry, IOL powers were chosen according to the child's age and IOL availability. RESULTS A total of 58 eyes from 33 children were surgically treated of which 25 (76%) were bilateral and 8 (24%) unilateral. Best refractive outcome was achieved with a 25 diopter (D) IOL implanted in children 5-8 years old. None of the children aged 1-7 years achieved the previously calculated target refraction. Results showed a marked myopic variability. The range of postoperative refraction was from - 15 D to + 12.5 D and a large number of children (n=11, 33%) did not attend for follow-up. CONCLUSION Implanting IOLs according to age groups is not a suitable surgical strategy even in resource-poor settings. Refractive outcomes were too variable with a marked myopic shift. Biometry and keratometry are required in order to undertake pediatric cataract surgery. Developing regional pediatric centres should be a focus of the VISION 2020 initiative.
Collapse
Affiliation(s)
- M Schulze Schwering
- Universitätsaugenklinik Tübingen, Schleichstr. 16, 72076, Tübingen, Deutschland,
| | | | | | | |
Collapse
|
43
|
Hager T, Schirra F, Seitz B, Käsmann-Kellner B. [Treatment of pediatric cataracts. Part 2: IOL implantation, postoperative complications, aphakia management and postoperative development]. Ophthalmologe 2013; 110:179-88; 189-90. [PMID: 23392839 DOI: 10.1007/s00347-012-2755-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is a lot of uncertainty concerning intraocular lens (IOL) implantation for pediatric cataracts. The appropriate age which ocular abnormalities are contraindications and according to which formula IOL should be calculated are controversial. In addition to the imperative of identifying postoperative complications, such as secondary cataract formation and secondary glaucoma in a sufficiently timely manner, a modern management of aphakia with refractive compensation and occlusion is necessary. Some easy rules can help prevent pitfalls.
Collapse
Affiliation(s)
- T Hager
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland.
| | | | | | | |
Collapse
|
44
|
Long T, Huang YS, Xie LX. Refractive accuracy after intraocular lens implantation in pediatric cataract. Int J Ophthalmol 2012; 5:473-7. [PMID: 22937508 DOI: 10.3980/j.issn.2222-3959.2012.04.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 07/27/2012] [Indexed: 11/02/2022] Open
Abstract
AIM To analyze the factors that influence the prediction error (PE) after intraocular lens (IOL) implantation in pediatric cataract. METHODS The medical records of cataract patients of no more than 14 years old who had primary IOL implantation were reviewed from 2006 to 2010. The PE, absolute value of PE (APE), and predictability between in different axial length, mean corneal curvature, corneal astigmatism, and age at the surgery were analyzed. RESULTS Seventy-five children (119 eyes) were included, with a mean age of (5.09±2.54) years. At the follow-up of (1.19±0.69) months, the mean postoperative PE was (-0.22±1.12) D, and APE was (0.87±0.73)D. The PE in eyes with an axial length >20mm but ≤22mm were significantly under-corrected than that in eyes with longer axis, and the APE in eyes with an axial length ≤20mm was more obvious compared with the others. The correlations between PE and axial length, as well as corneal astigmatism, and between APE and axial length were significant. The predictability was significantly poorer in the eyes with an axial length ≤20mm than the others. CONCLUSION The axial length is closely related with the PE after IOL implantation in pediatric cataract patients, especially when it is ≤20mm, PE is more significant. The formula that is more suitable to very short axial length should be explored.
Collapse
Affiliation(s)
- Tan Long
- Department of Ophthalmology, People's Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | | | | |
Collapse
|
45
|
Lin H, Chen W, Luo L, Congdon N, Zhang X, Zhong X, Liu Z, Chen W, Wu C, Zheng D, Deng D, Ye S, Lin Z, Zou X, Liu Y. Effectiveness of a short message reminder in increasing compliance with pediatric cataract treatment: a randomized trial. Ophthalmology 2012; 119:2463-70. [PMID: 22921386 DOI: 10.1016/j.ophtha.2012.06.046] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 06/24/2012] [Accepted: 06/27/2012] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Regular follow-up is essential to successful management of childhood cataract. We sought to assess whether a mobile phone short message service (SMS) for parents of children with cataract could improve follow-up adherence and the proportion of procedures performed in timely fashion. DESIGN Randomized, controlled trial. This trial is registered with ClinicalTrials.gov, NCT01417819. PARTICIPANTS We included 258 parent-child pairs involved in the Childhood Cataract Program of the Chinese Ministry of Health. METHODS Participants were randomized (1:1) to a mobile phone SMS intervention or standard follow-up appointments. All participants were scheduled to attend ≥ 4 follow-up appointments according to the protocol. Parents in the intervention group received SMS automated reminders before scheduled appointments. The control group parents did not receive SMSs or any alternative reminder of scheduled appointments. Regular ocular examinations and analyses were performed by investigators masked to group allocation; however, study participants and the manager in charge of randomization and sending SMSs were not masked. MAIN OUTCOME MEASURES Number of follow-up appointments attended, additional surgeries, laser treatments, changes in eyeglasses prescription, and occurrence of secondary ocular hypertension. RESULTS Among parent-child participants, 135 were randomly assigned to the SMS intervention and 123 to standard appointments. Attendance rates for the SMS group (first visit, 97.8%; second, 91.9%; third, 92.6%; fourth, 83%) were significantly higher than those for the control group (first visit, 87.8%; second, 69.9%; third, 56.9%; fourth, 33.3%). The increase in attendance rate for total number of follow-up visits with SMS reminders was 47.2% (relative risk [RR] for attendance, 1.47; 95% confidence interval [CI], 1.16-1.78; P = 0.003). The number needed to remind (NNR) to gain 1 additional visit by 1 child was 3 (95% CI, 1.8-4.2). A total of 247 clinical interventions were carried out in the SMS group and 134 in the control group (RR, 1.68; 95% CI, 1.37-1.99; P = 0.007). The NNR to result in 1 additional clinical intervention was 5 (95% CI, 3.5-6.5). CONCLUSIONS The SMS reminders significantly improved follow-up adherence in pediatric cataract treatment. Using readily available mobile phone resources may be an effective and economic strategy to improve management of childhood cataract in China. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Collapse
Affiliation(s)
- Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Al Shamrani M, Al Turkmani S. Update of intraocular lens implantation in children. Saudi J Ophthalmol 2012; 26:271-5. [PMID: 23961005 DOI: 10.1016/j.sjopt.2012.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/19/2012] [Accepted: 05/19/2012] [Indexed: 12/21/2022] Open
Abstract
Cataract is a common problem that affects the vision in children and a major cause of amblyopia in children. However, the management of childhood cataract is tenuous and requires special considerations especially with regard to intraocular lens (IOL) implantation. Age at which an IOL can be implanted is a controversial issue. Implanting an IOL in very young children carries the risk of severe postoperative inflammation and posterior capsule opacification that may need other surgeries and may affect the vision permanently. Accuracy of the calculated IOL power is affected by the short eyes and the steep keratometric values at this age. Furthermore, choosing an appropriate IOL power is not a straight forward decision as future growth of the eye affects the axial length and keratometry readings which may result in an unexpected refractive error as children age. The aim of this review is to cover these issues regarding IOL implantation in children; indications, timing of implantation, types of IOLs, site of implantation and the power calculations.
Collapse
Affiliation(s)
- Mohammed Al Shamrani
- Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | |
Collapse
|
47
|
Kim DH, Kim JH, Kim SJ, Yu YS. Long-term results of bilateral congenital cataract treated with early cataract surgery, aphakic glasses and secondary IOL implantation. Acta Ophthalmol 2012; 90:231-6. [PMID: 20819081 DOI: 10.1111/j.1755-3768.2010.01872.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the long-term visual outcome after early surgery of bilateral dense congenital cataracts, aphakic correction with glasses and secondary intraocular lens (IOL) implantation around 2 years of age. METHODS The medical records of paediatric patients who underwent cataract extraction, aphakic correction and secondary IOL implantation from 1993 to 2004 at Seoul National University Children's Hospital were reviewed retrospectively. Age at secondary IOL implantation, axial length (AL), best corrected visual acuity (BCVA), refractive error, ocular alignment, stereopsis, and postoperative ocular complications were recorded. RESULTS Thirty-seven paediatric bilateral pseudophakic patients were identified with a mean follow-up period of 81.4 months. Best corrected visual acuity of 20/40 or better were attained in 44.0% of eyes, and the median BCVA was 20/50. Preoperative factors associated with poor visual prognosis included cataract surgery after 8 weeks of age, interocular AL difference of 0.5 mm or more, and glaucoma. Amblyopic eyes showed more myopic change compared to fellow eyes. Good or moderate binocular function was achieved in 18.9% of all patients. Incidences of strabismus, glaucoma, posterior capsular opacity formation were 46.0%, 32.4% and 4.0%, respectively. CONCLUSION Good postoperative BCVA and binocular function were achieved in most healthy children with bilateral dense congenital cataract and no posterior segment pathology. Early cataract surgery, aphakic correction with glasses and secondary IOL implantation around 2 years of age appears to be appropriate methods.
Collapse
Affiliation(s)
- Dong-Hyun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | |
Collapse
|
48
|
Lambert SR, Archer SM, Wilson ME, Trivedi RH, del Monte MA, Lynn M. Long-term Outcomes of Undercorrection Versus Full Correction After Unilateral Intraocular Lens Implantation in Children. Am J Ophthalmol 2012; 153:602-8, 608.e1. [PMID: 22206805 DOI: 10.1016/j.ajo.2011.08.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 08/25/2011] [Accepted: 08/26/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the impact of full correction vs undercorrection on the magnitude of the myopic shift and postoperative visual acuity after unilateral intraocular lens (IOL) implantation in children. DESIGN Retrospective case control study. METHODS The medical records of 24 children who underwent unilateral cataract surgery and IOL implantation at 2 to <6 years of age were reviewed. The patients were divided into 2 groups based on their 1-month-postoperative refraction: Group 1 (full correction) -1.0 to +1.0 diopter (D) and Group 2 (undercorrection) ≥+2.0 D. The main outcome measures included the change in refractive error per year and visual acuity for the pseudophakic eyes at last follow-up visit. The groups were compared using the independent groups t test and Wilcoxon rank sum test. RESULTS The mean age at surgery (Group 1, 4.2±0.9 years, n=12; Group 2, 4.5±1.0 years, n=12; P=.45) and mean follow-up (Group 1, 5.8±3.7 years; Group 2, 6.1±3.5 years; P=.69) were similar for the 2 groups. The change in refractive error (Group 1, -0.4±0.5 D/y; Group 2, -0.3±0.2 D/y; P=.70) and last median logMAR acuity (Group 1, 0.4; Group 2, 0.4; P=.54) were not significantly different between the 2 groups. CONCLUSIONS We did not find a significant difference in the myopic shift or the postoperative visual acuity in children aged 2 to <6 years of age following unilateral cataract surgery and IOL implantation if the initial postoperative refractive error was near emmetropia or undercorrected by 2 diopters or more.
Collapse
|
49
|
Chan WH, Biswas S, Ashworth JL, Lloyd IC. Congenital and infantile cataract: aetiology and management. Eur J Pediatr 2012; 171:625-30. [PMID: 22383071 DOI: 10.1007/s00431-012-1700-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 02/09/2012] [Indexed: 11/30/2022]
Abstract
Congenital cataract is the commonest worldwide cause of lifelong visual loss in children. Although congenital cataracts have a diverse aetiology, in many children, a cause is not identified; however, autosomal dominant inheritance is commonly seen. Early diagnosis either on the post-natal ward or in the community is important because appropriate intervention can result in good levels of visual function. However, visual outcome is largely dependent on the timing of surgery when dense cataracts are present. Good outcomes have been reported in children undergoing surgery before 6 weeks of age in children with unilateral cataract and before 10 weeks of age in bilateral cases. Placement of an artificial intraocular lens implant after removal of the cataract has become established practice in children over 2 years of age. There remains debate over the safety and predictability of intraocular lens implantation in infants. Despite early surgery and aggressive optical rehabilitation, children may still develop deprivation amblyopia, nystagmus, strabismus, and glaucoma. The diagnosis and management of congenital cataracts has improved substantially over the past 30 years with a concurrent improvement in outcomes for affected children. Many aspects of the pre-, intra-, and postoperative management of these patients continue to be refined, highlighting the need for good quality data and prospective collaborative studies in this field.
Collapse
Affiliation(s)
- Wai H Chan
- Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Central Manchester Foundation Trust, The University of Manchester, Oxford Road, Manchester, M13 9WH, UK
| | | | | | | |
Collapse
|
50
|
Glued intrascleral fixation of posterior chamber intraocular lens in children. Am J Ophthalmol 2012; 153:594-601, 601.e1-2. [PMID: 22264692 DOI: 10.1016/j.ajo.2011.09.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/20/2011] [Accepted: 09/21/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the short-term results of glued intrascleral fixation of posterior chamber intraocular lens (glued IOL) in children without adequate capsular support. DESIGN Noncomparative retrospective observational case series. PATIENTS SETTING Institutional practice. METHODS Forty-one eyes of 33 children who underwent glued IOL implantation were retrospectively evaluated. The indications were postsurgical aphakia, subluxated cataract, ectopia lentis, traumatic subluxation, and decentered IOL. MAIN OUTCOME MEASURES Visual acuity (VA), endothelial cell changes, intraoperative and postoperative complications. RESULTS The mean age at the time of glued IOL was 10.7±3.6 years (range 5-15). The mean duration of follow-up after surgery was 17.5±8.5 months (range 12-36). The mean postoperative best spectacle-corrected visual acuity (BCVA in decimal equivalent) was 0.43±0.33 and there was significant change noted (P<0.001). Postoperatively, 20/20 and >20/60 BCVA was obtained in 17.1% and 46.3% of eyes respectively. BCVA improvement more than 1 line was seen in 22 eyes (53.6%). The mean postoperative refraction was myopic (-1.19±0.7 diopters [D]) in 19 eyes and hyperopic (+1.02±0.7 D) in 22 eyes. The mean endothelial loss was 4.13% (range 1.3%-5.94%). The 3 causes of reduced BCVA were the preexisting corneal, retinal pathology, and amblyopia. Postoperative complications included optic capture in 1 eye (2.4%), macular edema in 2 eyes (4.8%), and clinical decentration in 2 eyes (4.8%). There was no postoperative retinal detachment, IOL dislocation, endophthalmitis, or glaucoma. CONCLUSION Short-term results in children after glued IOL were favorable, with a low rate of complications. However, regular follow-ups are required since long-term risks are unknown.
Collapse
|