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Koshiishi Y, Nagata M, Matsushima H, Ito S, Suzuki S, Matsumoto H, Okayasu A, Senoo T. Unilateral lifebuoy cataract: A case report. Medicine (Baltimore) 2024; 103:e39359. [PMID: 39151503 PMCID: PMC11332702 DOI: 10.1097/md.0000000000039359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/19/2024] Open
Abstract
RATIONALE Lifebuoy cataract is a rare congenital condition characterized by lens thinning. Due to its rarity, detailed treatment reports and standardized surgical approaches are limited. This study aims to enhance the current body of knowledge by presenting comprehensive case reports and describing surgical techniques for the treatment of lifebuoy cataracts. PATIENT CONCERNS A 14-year-old boy was diagnosed with a congenital cataract in his right eye at the age of 9, which was left untreated. The patient visited our hospital due to progressive visual impairment. DIAGNOSES The visual acuity of the right eye was counting fingers at 30 cm. The uncorrected visual acuity of the left eye was 20/100, whereas the best corrected visual acuity was 20/20. The intraocular pressures were 18 mm Hg (left eye) and 20 mm Hg (right eye). Slit-lamp microscopy revealed central calcification of the lens capsule in the right eye and slightly opaque cortical tissue in the periphery, with no observable lens nucleus. Anterior segment optical coherence tomography (CASIA2, TOMEY, Nagoya, Japan) of the right eye showed fused anterior and posterior capsules and an absence of the lens nucleus, leading to a diagnosis of lifebuoy cataract. INTERVENTIONS Cataract surgery was performed on the right eye. Following a 2.4-mm sclerocorneal incision and trypan blue staining, continuous curvilinear capsulorrhexis was performed around the central opacity. The surrounding cortex was removed using irrigation and aspiration, while a viscoelastic agent was injected between the central calcified membrane and the posterior capsule. The membranous tissue was carefully peeled away and removed using forceps. Despite residual posterior capsular opacification, posterior capsulotomy was not performed due to concerns about vitreous prolapse. The intraocular lens was fixed within the capsule. Ten days post-surgery, the remaining posterior capsular opacification was treated with neodymium-doped yttrium aluminum garnet laser capsulotomy. OUTCOMES The uncorrected visual acuity and best corrected visual acuity of the right eye improved to 20/100 and 20/50, respectively. LESSONS This case report demonstrates a successful surgical approach for a lifebuoy cataract, highlighting its unique morphology and the need for careful, specialized techniques. These findings aim to guide ophthalmologists in managing this rare condition, potentially improving patient care.
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Affiliation(s)
- Yuka Koshiishi
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Mayumi Nagata
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Hiroyuki Matsushima
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Sakae Ito
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Shigenari Suzuki
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Haruka Matsumoto
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Akihiko Okayasu
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Tadashi Senoo
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
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Sand MK, Cholidis S, Kristianslund O, Drolsum L. Bag-in-the-lens intraocular lens implantation before 12 weeks of age in congenital cataract. Acta Ophthalmol 2023. [PMID: 36808711 DOI: 10.1111/aos.15647] [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: 10/07/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/20/2023]
Abstract
PURPOSE The aim of this study was to evaluate the intra- and postoperative complications, especially the risk of visual axis opacification (VAO), following the implantation of the bag-in-the-lens (BIL) intraocular lens (IOL) in infants with congenital cataract operated on before 12 weeks of age. METHODS Infants operated on before 12 weeks of age between June 2020 and June 2021 with a follow-up longer than 1 year were included in the present retrospective study. This was a first-experience cohort of an experienced paediatric cataract surgeon with this type of lens. RESULTS Nine infants (13 eyes) with a median age at surgery of 28 days (range, 21-49 days) were included. The median follow-up time was 21.6 months (range, 12.2-23.4 months). The lens was correctly implanted with the anterior and posterior capsulorhexis edges placed into the interhaptic groove of the BIL IOL in seven of 13 eyes; none of these eyes developed VAO. In the remaining six eyes, the IOL was only fixated to the anterior capsulorhexis edge, and in these cases, an anatomical anomaly of the posterior capsule and/or anterior vitreolenticular interface dysgenesis were observed. These six eyes developed VAO. One eye had a partial iris capture in the early postoperative phase. Otherwise, the IOL remained well centred and stable in all eyes. Anterior vitrectomy was necessary in seven eyes due to vitreous prolapse. One patient with unilateral cataract was diagnosed with bilateral primary congenital glaucoma at 4 months of age. CONCLUSION Implantation of the BIL IOL is safe even in the youngest age group less than 12 weeks of age. Although being a first-experience cohort, the BIL technique is shown to reduce the risk of VAO and the number of surgical procedures.
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Affiliation(s)
- Mari Kathrine Sand
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Symira Cholidis
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Wackerberg D, Nyström A, Haargaard B, Rosensvärd A, Tornqvist K, Borg L, Kugelberg M, Gyllén J, Magnusson G. Analysis of age at detection and outcomes of dense unilateral congenital cataract surgery for children on the paediatric cataract register. Acta Paediatr 2023; 112:277-285. [PMID: 36366873 PMCID: PMC10098656 DOI: 10.1111/apa.16591] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
AIM Analysis of age at time of detection and surgery of dense unilateral cataract and investigation of best-corrected visual acuity (BCVA) in a nationwide register-based cohort study, based on the routine of maternity ward eye screening. METHODS Data were derived from the Paediatric Cataract Register (PECARE). All children (n = 54) diagnosed with dense congenital unilateral cataract between January 2007 and September 2014 who had surgery before 1 year of age, and for whom 5-year follow-up records were available, were included. RESULTS The majority, 35/54 (65%), were detected and operated on before age 6 weeks and 30/35 (86%) were referred from maternity wards. Visual acuity (VA) ≥ 0.5 (decimal, 0.3 logMAR) was found in 7/53 (13%) of the cohort at age 5 years; further, 19 children achieved VA ≥ 0.1 (decimal, 1.0 logMAR) (36%) and 19 children VA < 0.05 (decimal, 1.30 logMAR) (36%). Ten-year follow-up records were available for 17/53 (32%) children; 1/17 (6%) achieved VA ≥ 0.5 (decimal, 0.3 logMAR), 4/17 (24%) VA ≥ 0.3-<0.5 (decimal, 0.52-0.30 logMAR), 3/17 (18%) VA ≥ 0.05-0.1 (decimal, 1.30-1.0 logMAR) and 10/17 (59%) VA < 0.05 (decimal, 1.30 logMAR). CONCLUSION A total of 90% of the children were detected with cataract within 100 days of birth and 80% were operated on within this period. This study showed better visual acuity in those treated for dense unilateral cataracts than previously reported in an earlier Swedish cohort study.
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Affiliation(s)
- David Wackerberg
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden
| | - Alf Nyström
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birgitte Haargaard
- Department of Opthalmology, Naestved Hospital, Naestved, Denmark.,Danish Serum Institute, Copenhagen, Denmark
| | - Annika Rosensvärd
- Division of Ophthalmology and Vision, Department of Clinical Neuroscience, Karolinska Institutet, St Erik Eye Hospital, Stockholm, Sweden
| | - Kristina Tornqvist
- Department of Clinical Sciences, Ophthalmology, Skane University Hospital, Lund University, Lund, Sweden
| | - Lovisa Borg
- Department of Medicine, Trelleborg Hospital, Trelleborg, Sweden
| | - Maria Kugelberg
- Division of Ophthalmology and Vision, Department of Clinical Neuroscience, Karolinska Institutet, St Erik Eye Hospital, Stockholm, Sweden
| | - Jenny Gyllén
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunilla Magnusson
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lytvynchuk LM, Thiele MV, Schmidt W, Lorenz B. Precision of bag-in-the-lens intraocular lens power calculation in different age groups of pediatric cataract patients: Report of the Giessen Pediatric Cataract Study Group. J Cataract Refract Surg 2020; 45:1372-1379. [PMID: 31564311 DOI: 10.1016/j.jcrs.2019.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the precision of bag-in-the-lens intraocular lens (BIL IOL) power calculation in different age groups of pediatric cataract patients. SETTINGS Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany. DESIGN Retrospective nonrandomized consecutive case series. METHODS Pediatric patients diagnosed with cataract and operated with BIL IOL implantation were divided into 4 age groups: Group 1 (0 to 3 months), Group 2 (>3 months, <12 months), Group 3 (12 to 36 months), and Group 4 (>36 months to 17 years). BIL IOL power was calculated with the SRK/T formula. The prediction error (PE) was defined as the absolute difference between the preoperative selected target and postoperative achieved refraction. The impact of age at the time of surgery, axial length (AL), keratometry, and corneal astigmatism on PE was analyzed. RESULTS The study comprised 87 eyes of 56 pediatric patients. The mean and median PEs for the entire group were 1.79 diopters (D) and 1.23 D, respectively. The mean PE in each age group was: 3.43 D in Group 1, 2.14 D in Group 2, 1.60 D in Group 3, and 1.33 D in Group 4. The mean PE in eyes with ALs shorter than 20 mm was 2.67 D, and 1.44 D in eyes with an AL of 20 mm or longer. The mean PE in eyes with corneal radii less than 7.3 mm was 2.45 D, and 1.66 D in eyes with corneal radii of 7.3 mm or more. In the age and AL subgroups, the PE differences were statistically significant (P < .05). CONCLUSIONS The PE was larger in the youngest study group, and it decreased gradually with age and in eyes with ALs shorter than 20 mm. The PE has to be considered during BIL IOL power calculation in children.
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Affiliation(s)
- Lyubomyr M Lytvynchuk
- Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Maximilian V Thiele
- Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Werner Schmidt
- Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Birgit Lorenz
- Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Giessen, Germany.
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Femtosecond laser-assisted anterior and posterior capsulotomies in children with persistent hyperplastic primary vitreous. J Cataract Refract Surg 2020; 46:497-502. [PMID: 32271292 DOI: 10.1097/j.jcrs.0000000000000139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Anterior and posterior capsulotomies were performed in 12 eyes of 12 patients (age range 3 months to 6 years) with congenital cataracts and primary persistent hyperplastic primary vitreous (PHPV) syndrome using a femtosecond laser. The procedure was performed in 8 eyes with PHPV severity level 1 and 4 eyes with severity level 2 (Sudovsky classification). Surgeries were performed at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Russia. Postoperative follow-up was between 8 months and 36 months. The use of a low-energy femtosecond laser-assisted posterior capsulotomy in this pediatric population provided safe and predictable results with a reduced number of intraocular manipulations, and reduced the risk for complications.
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6
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Kuhli-Hattenbach C, Fronius M, Kohnen T. [Timing of congenital cataract surgery : Amblyopia versus aphakic glaucoma]. Ophthalmologe 2020; 117:190-198. [PMID: 32076840 DOI: 10.1007/s00347-020-01053-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A congenital cataract is a rare disorder, which is associated with a high risk of amblyopia. Ophthalmologists are faced with many diagnostic and surgical challenges in the management of this disease. Older children can undergo primary treatment with an intraocular lens, whereas children younger than 12 months of age usually initially remain aphakic. The most frequent long-term complication of aphakic eyes following congenital cataract surgery in connection with posterior capsulorrhexis and anterior vitrectomy is aphakic glaucoma, which in individual cases can lead to substantial impairment of vision. Many factors have been reported to increase the risk of postoperative glaucoma, including microphthalmos, fetal nuclear cataract, conspicuous family history and associated ocular malformations, such as persistent fetal vasculature (PFV). Cataract surgery during early infancy is well-established to be the most important factor for the formation of postoperative aphakic glaucoma. In individual treatment planning it has to be considered that although younger age at the time of cataract removal can provide better prerequisites for prophylaxis of amblyopia, it also confers a higher risk of development of aphakic glaucoma. Children undergoing congenital cataract surgery have to be regularly monitored given the lifelong risk for postoperative complications, such as aphakic glaucoma.
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Affiliation(s)
- C Kuhli-Hattenbach
- Klinik für Augenheilkunde, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - M Fronius
- Klinik für Augenheilkunde, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - T Kohnen
- Klinik für Augenheilkunde, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
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7
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Lytvynchuk LM, Thiele MV, Lorenz B. Analysis and management of intraoperative and early postoperative complications of bag-in-the-lens intraocular lens implantation in different age groups of paediatric cataract patients: report of the Giessen Paediatric Cataract Study Group. Acta Ophthalmol 2020; 98:e144-e154. [PMID: 31421029 DOI: 10.1111/aos.14229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/23/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To report the rate and management of intra- and early postoperative complications of bag-in-the-lens intraocular lens (IOL) implantation technique for cataract treatment in paediatric patients of different age groups. SETTINGS Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany. DESIGN Retrospective non-randomized consecutive case series. METHODS Ninety eyes of 60 paediatric cataract patients were enrolled to this retrospective non-randomized observational consecutive case series single-centre study. All patients underwent cataract surgery with bag-in-the-lens IOL implantation between January 2008 and December 2018, performed by two experienced surgeons. The entire cohort was divided into four age groups: first - 0-<3 months, second - 3-<12 months, third - 12-<36 and fourth - >36 months-17 years of age. The intra- and postoperative complications were based on the clinical records. The description of management of complications related specifically to bag-in-the-lens IOL technique was based on the 39 consecutive cases operated since 1 Jan 2016 by one single surgeon that were all video documented. The early postoperative period was defined as 12 months after surgery. RESULTS Overall, there were 27 unilateral and 33 bilateral surgical cases of 24 female and 36 male children. The mean age at surgery was 45.25 months (range 1-200 months). The most common intraoperative events were vitreous prolapse and anterior capsule rupture with 28.9% and 13.3%, respectively. Within 12 months of follow-up, five eyes (5.6%) were re-operated because of visual axis reo-pacification (VAR). Intraocular hypertension was diagnosed in seven eyes (7.8%), including two cases that required surgical treatment. In all cases with intra- and early postoperative complications related specifically to bag-in-the-lens technique, it was possible to manage them and successfully implant bag-in-the-lens IOL. CONCLUSIONS Implementation of bag-in-the-lens technique in the treatment of paediatric cataract was associated with a relatively low rate of intra- and postoperative complications, including rare cases of VAR. The correct management of complications related specifically to bag-in-the-lens IOL implantation technique shall to be considered during the learning curve.
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Affiliation(s)
- Lyubomyr M. Lytvynchuk
- Department of Ophthalmology Justus‐Liebig‐University Giessen University Hospital Giessen and Marburg GmbH Giessen Germany
| | - Maximilian V. Thiele
- Department of Ophthalmology Justus‐Liebig‐University Giessen University Hospital Giessen and Marburg GmbH Giessen Germany
| | - Birgit Lorenz
- Department of Ophthalmology Justus‐Liebig‐University Giessen University Hospital Giessen and Marburg GmbH Giessen Germany
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8
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Wernecke L, Keckeis S, Reichhart N, Strauß O, Salchow DJ. Epithelial-Mesenchymal Transdifferentiation in Pediatric Lens Epithelial Cells. Invest Ophthalmol Vis Sci 2019; 59:5785-5794. [PMID: 30521667 DOI: 10.1167/iovs.18-23789] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Posterior capsule opacification (PCO) is a complication after cataract surgery, particularly in children. Epithelial-mesenchymal transition (EMT) of lens epithelial cells, mediated by transforming growth factor beta (TGFβ), contributes to PCO. However, its pathogenesis in children is poorly understood. We correlated cell growth in culture with patient characteristics, studied gene expression of pediatric lens epithelial cells (pLEC), and examined the effects of TGFβ-2 on these cells in vitro. Methods Clinical characteristics of children with cataracts correlated with growth behavior of pLEC in vitro. mRNA expression of epithelial (αB-crystallin, connexin-43) and mesenchymal (αV-integrin, α-smooth muscle actin, collagen-Iα2, fibronectin-1) markers was quantified in pLEC and in cell line HLE-B3 in the presence and absence of TGFβ-2. Results Fifty-four anterior lens capsules from 40 children aged 1 to 180 months were obtained. Cell outgrowth occurred in 44% of the capsules from patients ≤ 12 months and in 33% of capsules from children aged 13 to 60 months, but in only 6% of capsules from children over 60 months. TGFβ-2 significantly upregulated expression of αB-crystallin (HLE-B3), αV-integrin (HLE-B3), collagen-Iα2, and fibronectin-1 (in pLEC and HLE-B3 cells). Conclusions Patient characteristics correlated with growth behavior of pLEC in vitro, paralleling a higher clinical incidence of PCO in younger children. Gene expression profiles of pLEC and HLE-B3 suggest that upregulation of αV-integrin, collagen-Iα2, and fibronectin-1 are involved in EMT.
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Affiliation(s)
- Laura Wernecke
- Experimental Ophthalmology, Department of Ophthalmology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Ophthalmology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Susanne Keckeis
- Experimental Ophthalmology, Department of Ophthalmology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nadine Reichhart
- Experimental Ophthalmology, Department of Ophthalmology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Olaf Strauß
- Experimental Ophthalmology, Department of Ophthalmology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel J Salchow
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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9
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Van Looveren J, Van Gerwen V, Schildermans K, Laukens K, Baggerman G, Tassignon MJ. Proteomic analysis of posterior capsular plaques in congenital unilateral cataract. Acta Ophthalmol 2018; 96:e963-e969. [PMID: 30280517 DOI: 10.1111/aos.13782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/12/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To obtain insights on the protein composition of posterior capsular plaques (PCP) in congenital unilateral cataract with anterior vitreolenticular interface dysgenesis (AVLID). METHODS Posterior capsular plaque's were collected during surgery in children presenting with congenital unilateral cataract. Surgeries were analysed focusing on the type of cataract, the integrity of the posterior capsule after peeling the PCP and the presence of vitreolenticular adherences when performing primary posterior capsulorhexis. Proteome analysis was performed on the collected PCPs. RESULTS Posterior capsular plaques collection and proteome analysis were feasible from four children presenting with unilateral idiopathic congenital cataract and AVLID. A large portion of the proteins found in the PCPs was similar to the proteins known to be present in lens epithelial cells and fibres. Proteins like vimentin, fibronectin, collagen type I, collagen type VI and lumican were also found, which typically are present in mesenchymal tissue but not in lens tissue or capsule. CONCLUSION Posterior capsular plaques in cases of unilateral idiopathic congenital cataract of the AVLID type present a protein composition of mainly proteins found in lens epithelial cells and fibres. Some proteins however are a specific for lens tissue and are typically seen in mesenchymal tissue.
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Affiliation(s)
- Jan Van Looveren
- Department of Ophthalmology; Antwerp University Hospital; Edegem Belgium
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | - Veerle Van Gerwen
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | | | - Kris Laukens
- Department of Mathematics and Computer Science; University of Antwerp; Antwerp Belgium
| | - Geert Baggerman
- Centre for Proteomics; University of Antwerp; Wilrijk Belgium
| | - Marie-José Tassignon
- Department of Ophthalmology; Antwerp University Hospital; Edegem Belgium
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
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10
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Xie YB, Ren MY, Wang Q, Wang LH. Intraocular lens optic capture in pediatric cataract surgery. Int J Ophthalmol 2018; 11:1403-1410. [PMID: 30140648 DOI: 10.18240/ijo.2018.08.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/27/2018] [Indexed: 12/28/2022] Open
Abstract
Posterior capsule opacification (PCO) remains the most common complication of pediatric cataract surgery despite continuous efforts to reduce its incidence. For this reason, pediatric cataract surgeons have expended considerable effort into preventing and mitigating PCO. The intraocular lens (IOL) optic capture technique has been used for the prevention of PCO after pediatric cataract surgery for more than 20y, but there is still no professional consensus. However, recent research has shown encouraging results. The IOL optic capture technique can be performed without anterior vitrectomy to prevent PCO, even in younger children. The type and characteristics of IOLs used for optic capture technique, the location of IOL and the complications of IOL optic capture in children are here reviewed.
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Affiliation(s)
- Ying-Bin Xie
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Mei-Yu Ren
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Qi Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Li-Hua Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
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11
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Whelan RJ, Saccomano B, King R, Dorris K, Hemenway M, Hankinson TC, Liu AK. Radiation-induced Cataracts in Children With Brain Tumors Receiving Craniospinal Irradiation. J Pediatr Hematol Oncol 2018; 40:304-305. [PMID: 29621062 DOI: 10.1097/mph.0000000000001142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Radiation is a well-known cause of the development of cataracts. For children with brain tumors, craniospinal irradiation (CSI) would be expected to result in a significant risk of cataract development. We reviewed the incidence of cataracts in children with brain tumors who received CSI at our institution. Of 45 children who received CSI and had ophthalmologic examinations, 13 developed cataracts. The median time to develop cataracts was 27.6 months. Seven children underwent surgery for cataract. Given this high incidence of cataracts, we suggest routine eye examinations for all children receiving CSI.
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Affiliation(s)
| | | | | | - Kathleen Dorris
- Department of Pediatrics, Division of Pediatric Hematology/Oncology/Bone Marrow Transplantation, Children's Hospital Colorado, Aurora, CO
| | - Molly Hemenway
- Department of Pediatrics, Division of Pediatric Hematology/Oncology/Bone Marrow Transplantation, Children's Hospital Colorado, Aurora, CO
| | | | - Arthur K Liu
- Radiation Oncology, University of Colorado School of Medicine
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12
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Kuhli-Hattenbach C, Fronius M, Kohnen T. [Impact of timing of surgery on outcome in children with bilateral congenital cataract]. Ophthalmologe 2017; 114:252-258. [PMID: 27461015 DOI: 10.1007/s00347-016-0326-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The optimal time for surgical intervention in bilateral congenital cataract is still a matter of controversy. OBJECTIVES Herein, we evaluated clinical and functional results after bilateral congenital cataract surgery and performed subgroup analysis based on the age at the time of surgery. MATERIALS AND METHODS We retrospectively reviewed the records of 52 eyes of 26 children who underwent surgery for bilateral congenital cataract without intraocular lens implantation within the first 12 months of life; 16 eyes underwent phacoaspiration within the first 10 weeks of life (group A) and 26 eyes had cataract extraction at an age of >10 weeks (group B). We defined the primary outcome measure to be the prevalence of mild, moderate, and severe amblyopia in relationship to age-dependent visual acuity norms after a mean follow-up of 59.7 ± 43.2 months. Secondary outcome measures were interocular difference of visual acuity and the presence of strabismus, nystagmus, posterior capsule opacification, and aphakic glaucoma. RESULTS The prevalence of amblyopia was not statistically different between the two age groups. Of all children, 62.5 % (A) and 61.1 % (B) developed age-dependent normal visual acuity or mild amblyopia. However, the younger cohort developed significantly less strabismus than the older cohort (P = 0.03). There was a strong relationship between cataract surgery within the first 14 weeks of life and the development of aphakic glaucoma. All children developing secondary cataract formation underwent cataract surgery in the first 20 weeks of life. CONCLUSIONS Our results suggest that long-term prevalence of mild, moderate, and severe amblyopia is similar between the two cohorts of bilateral congenital cataract eyes based on the age ≤ or >10 weeks at the time of surgery. Because there is a strong relationship between postoperative complications and a young age at the time of cataract surgery, close postoperative follow-up is essential. Strabismus is less likely to develop in infants after bilateral cataract surgery within the first 10 weeks of life.
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Affiliation(s)
- C Kuhli-Hattenbach
- Klinik für Augenheilkunde, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - M Fronius
- Klinik für Augenheilkunde, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - T Kohnen
- Klinik für Augenheilkunde, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
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Prasad S, Ram J, Sukhija J, Pandav SS, Gupta PC. Cataract surgery in infants with microphthalmos. Graefes Arch Clin Exp Ophthalmol 2015; 253:739-43. [PMID: 25592478 DOI: 10.1007/s00417-014-2908-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To report the postoperative outcomes of cataract surgery in microphthalmic eyes of infants. METHODS This prospective observational study was carried out on 20 infants with microphthalmos with visually significant cataract. Microphthalmos was defined as axial length of the globe 16.50 mm or less. We excluded eyes with ocular trauma, inflammation, posterior hyperplastic primary vitreous or a tractional retinal detachment, aniridia, or chorioretinal coloboma. All the infants enrolled in this study underwent phacoaspiration with primary posterior capsulotomy, anterior vitrectomy, and peripheral iridectomy. Intraocular lens was not implanted in these children. Post-operative evaluation included refractive errors, irregularity of pupil, posterior synechiae, visual axis obscuration, and intraocular pressure. These children were followed up for a minimum of 12 months. RESULTS We evaluated 37 eyes of 20 infants, of whom 17 infants had bilateral and three infants had unilateral cataract. The mean age of the children and the mean axial length at the time of surgery were 3.78 ± 2.25 months and 15.76 ± 0.56 mm respectively. The complications observed were irregularity of pupil in seven eyes (18.9 %), glaucoma in five eyes (13.5 %), posterior synechiae in two eyes (5.2 %), visual axis obscuration due to posterior capsule opacification (PCO) in two eyes (5.2 %) and phthisis in one eye (2.7 %). CONCLUSION Infants achieved a favorable outcome after phacoaspiration with primary posterior capsulotomy with anterior vitrectomy. However, these children must be followed up to detect and treat postoperative complications such as visual axis obscuration, posterior synechiae, and glaucoma to achieve optimal outcome.
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Affiliation(s)
- Shrikant Prasad
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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14
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Li Q, Fu T, Li ZE, Bi HS, Wang XR, Dong M, Xin T. Optical correction of aphakia following unilateral infantile cataract removal. Acta Ophthalmol 2014; 92:e657-62. [PMID: 24930475 DOI: 10.1111/aos.12465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/08/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare primary intra-ocular lens (IOL) implantation with use of press-on spherical lens for aphakia correction following unilateral infantile cataract removal. METHODS Sixty infants with a unilateral cataract underwent cataract surgery and were randomly assigned to the IOL (A group) or no IOL group (B group). Residual refractive error was corrected with spectacles in the A group and a press-on spherical lens was used to treat aphakia in the B group. Grating visual acuity (VA) was measured and patients were followed for up to 1 year. RESULTS LogMAR VA in the operated eyes of both groups was significantly better 1 year than 1 month after surgery. Mean logMAR VA difference between 1 year and 1 month after surgery was higher in the A group (0.457 ± 0.110) than in the B group (0.323 ± 0.114, p < 0.0001). Serious inflammation occurred significantly more often in the A group than in the B group (p = 0.007). Visual axis opacity occurred more often in the A group than in the B group (pupillary membrane: A: six eyes, 20%, B: none, p = 0.024; lens reproliferation: A: 10 eyes, 33%, B: two eyes, 7%, p = 0.021). Glaucoma occurred equally in both groups (p = 0.612). No other complications occurred. CONCLUSIONS Primary IOL implantation appears to be a relatively safe, effective optical correction strategy following unilateral cataract extraction in this age group. Patients for whom an IOL is not suitable can be treated with a press-on spherical lens for optical correction.
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Affiliation(s)
- Qian Li
- Shandong University of Traditional Chinese Medicine; Jinan China
- Department of Ophthalmology; The Second People's Hospital of Jinan; Jinan China
| | - Te Fu
- Department of Ophthalmology; The Second People's Hospital of Jinan; Jinan China
| | - Zhong-En Li
- Department of Ophthalmology; Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine; Jinan China
| | - Hong-Sheng Bi
- Department of Ophthalmology; Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine; Jinan China
| | - Xing-Rong Wang
- Department of Ophthalmology; Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine; Jinan China
| | - Min Dong
- Department of Ophthalmology; The Second People's Hospital of Jinan; Jinan China
| | - Tian Xin
- Department of Ophthalmology; The Second People's Hospital of Jinan; Jinan China
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15
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Gangalum RK, Jing Z, Bhat AM, Lee J, Nagaoka Y, Deng SX, Jiang M, Bhat SP. Expression of the HSF4 DNA binding domain-EGFP hybrid gene recreates early childhood lamellar cataract in transgenic mice. Invest Ophthalmol Vis Sci 2014; 55:7227-40. [PMID: 25168898 DOI: 10.1167/iovs.14-14594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The clinical management of cataracts in infancy involves surgical removal of the lens to ensure transmission of light to the retina, which is essential for normal neural development of the infant. This surgery, however, entails a lifelong follow-up and impaired vision. To our knowledge, no animal models recapitulate human lamellar opacities, the most prevalent form of early childhood cataracts. We present data on the recreation of the human lamellar cataract phenotype in transgenic mice. METHODS Mutations in the DNA binding domain (DBD) of the heat shock transcription factor 4 (HSF4) are known to be associated with early childhood autosomal dominant lamellar cataract. We used bacterial artificial chromosome (BAC) transgenesis to express a hybrid gene: Hsf4 (DBD)-enhanced green fluorescent protein (EGFP), by recombineering EGFP sequences into the DBD of the Hsf4 gene, to interfere with the DNA binding properties of Hsf4. RESULTS We recapitulated the human lamellar cataract, in its temporal as well as spatial presentation, within the transgenic mouse lens. This phenotype was reproduced faithfully using four different BACs, indicating that EGFP can be used to target transcription factor function in transgenic mice. Molecular and cell biological examination of early postnatal transgenic lens reveals impairment of secondary fiber cell differentiation. CONCLUSIONS Recreation of the human lamellar cataract phenotype in mice allows investigation of this human pathology at a level not possible previously and points to the relevance of fiber cell heterogeneity dictated by fiber cell-specific gene activity in the biogenesis of the lamellar cataract.
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Affiliation(s)
- Rajendra K Gangalum
- Jules Stein Eye Institute, Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States
| | - Zhe Jing
- Jules Stein Eye Institute, Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States
| | - Ankur M Bhat
- Jules Stein Eye Institute, Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States
| | - Josh Lee
- Jules Stein Eye Institute, Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States Department of Molecular and Medical Pharmacology, Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States Molecular Biology Institute and Brain Research Institute, University of California Los Angeles, Los Angeles, California, United States
| | - Yoshiko Nagaoka
- Department of Molecular and Medical Pharmacology, Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States
| | - Sophie X Deng
- Molecular Biology Institute and Brain Research Institute, University of California Los Angeles, Los Angeles, California, United States
| | - Meisheng Jiang
- Department of Molecular and Medical Pharmacology, Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States
| | - Suraj P Bhat
- Jules Stein Eye Institute, Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States Molecular Biology Institute and Brain Research Institute, University of California Los Angeles, Los Angeles, California, United States
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Jing Z, Gangalum RK, Bhat AM, Nagaoka Y, Jiang M, Bhat SP. HSF4 mutation p.Arg116His found in age-related cataracts and in normal populations produces childhood lamellar cataract in transgenic mice. Hum Mutat 2014; 35:1068-71. [PMID: 24975927 DOI: 10.1002/humu.22610] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/17/2014] [Indexed: 12/19/2022]
Abstract
The p.Arg116His mutation in the heat shock transcription factor-4 (HSF4) has been associated with age-related cataracts, but it is also seen in 2% of the normal population, indicating either reduced penetrance or that the normal subjects were not old enough to express the phenotype. Based on the proximity of p.Arg116His to two known mutations in the DNA-binding domain of HSF4, namely, p.Leu114Pro and p.Arg119Cys, which segregate with childhood lamellar cataract, we tested the possibility that this phenotype may have been missed by the ophthalmologist and/or that it did not spread to the visual axis so as to affect vision significantly. Here, we demonstrate via BAC (bacterial artificial chromosome) transgenesis that p.Arg116His recreates the childhood lamellar cataract in mice suggesting that incomplete penetrance associated with early cataracts may not be an absence but a limitation of the detection of the phenotype.
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17
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Jusufovic V, Cabric E, Popovic-Beganovic A, Musanovic Z, Zvornicanin J. Treatment of congenital aniridia associated with subluxated infantile cataract. Med Arch 2014; 68:212-4. [PMID: 25568537 PMCID: PMC4240328 DOI: 10.5455/medarh.2014.68.212-214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/15/2014] [Indexed: 11/03/2022] Open
Abstract
A 5 year old boy was presented at Eye clinic University clinical center Tuzla with congenital aniridia in both eyes. Clinical examination revealed visual acuity of 0,08 without correction in right and 0.7 with -5.0 Dsph and -1.0 Dcyl Axx 109° in left eye. Opthalmologic examination showed bilateral aniridia associated with moderate cataract in the right and incipient cataract in the left eye. In the right eye, zonular weakness with incipient capsular displacement and esotropia of Δ6º, were noted. The patient underwent phacoemulsification, implantation of capsular tension ring and Artificial Iris implant in the capsular bag. Phacoemulsification went uneventful and early postoperative recovery was successful with no signs of aniridia-associated keratopathy development and normal values of intra ocular pressure. Patient was not motivated for operation of the left eye and it was corrected with soft contact lens. Six month after the operation visual acuity in the right eye improved to 0.9 with +1.25Dsph and maintained stable in left eye, with complete elimination of esotropia and signs of binocular vision restoration. Small incision cataract extraction with IOL and Artificial Iris implantation in one procedure can be used to correct congenital aniridia and cataract with significant visual function improvement.
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Affiliation(s)
- Vahid Jusufovic
- Eye Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Emir Cabric
- Public Health Care Institution Doboj-Jug, Matuzici, Bosnia and Herzegovina
| | | | - Zlatko Musanovic
- Eye Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Jasmin Zvornicanin
- Eye Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
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Hennig A, Schroeder B, Gilbert C. Bilateral pediatric cataract surgery: outcomes of 390 children from Nepal and Northern India. J Pediatr Ophthalmol Strabismus 2013; 50:312-9. [PMID: 23565713 DOI: 10.3928/01913913-20130402-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 03/04/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the outcomes of bilateral pediatric cataract surgery from eastern Nepal and northern India. METHODS Preoperative, intraoperative, and postoperative data of 390 children who underwent surgery bilaterally between 2007 and 2009 were analyzed. RESULTS Forty-two (10.8%) children came from Nepal and 348 (89.2%) from India (mainly Bihar State). Intraocular lens (IOL) implantation with posterior capsule opening and anterior vitrectomy were achieved in 386 (99.0%) children bilaterally. Median age at surgery was 7 years and 69.2% were male. At first presentation, 243 (62.3%) of the children were blind (< 3/60 in the better eye). After more than 1 year, 53.5% had a normal visual status (range: 6/6 to 6/18), 5.6% of children were still blind, and mean refractive error spherical equivalent was +1.0 ± 2.4 diopters. Astigmatism changed from suture-induced with the rule at discharge to against the rule within 3 weeks of surgery. Mean long-term astigmatic error was 1.0 ± 0.9 diopters after 1 year. Glaucoma was rare. CONCLUSIONS Even in a setting with limited resources, successful, cost-effective, high-volume surgery for pediatric cataract is possible. Despite late presentation and limited follow-up, more than half achieved good outcomes after more than 1 year. Only 5.6% remained blind due to amblyopia or eye anomalies. Bilateral surgery during one hospital stay, IOL implantation with undercorrection according to age, aggressive surgery to prevent secondary cataract, intensive anti-inflammatory therapy, and provision of durable, high-quality spectacles to take home all proved beneficial because many children cannot attend for regular follow-up.
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19
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Isolated congenital hereditary cataract in a dizygotic twin: prenatal ultrasonographic diagnosis. Twin Res Hum Genet 2013; 16:994-7. [PMID: 23931615 DOI: 10.1017/thg.2013.50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cataract, defined as opacity of the lens in one or both eyes, is a major cause of blindness throughout the world, and not uncommon, particularly in the elderly population. However, congenital cataracts are rare and occur with a frequency of 30 cases in 100,000 births. About one-third of the cases fall into the group inherited without systemic abnormality. Importantly, congenital cataracts produce deprivation amblyopia, refractive amblyopia, and retinal detachment, leading to lifelong visual impairment. Successful management is dependent on early diagnosis and referral for surgery when indicated. Here we present a case of hereditary bilateral cataracts in a dizygotic twin detected on prenatal ultrasound examinations and postnatally confirmed as congenital cataracts associated with posterior lenticonus.
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20
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Advances in the management of the surgical complications for congenital cataract. Front Med 2012; 6:360-5. [PMID: 23224414 DOI: 10.1007/s11684-012-0235-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022]
Abstract
The greatest concern in children with cataracts is irreversible visual loss. The timing of congenital cataract surgery is critical for the visual rehabilitation. Cataract surgery in children remains complex and challenging. The incidence of complications during or after operation is higher in children than adults. Some complications could be avoided by meticulous attention to surgical technique and postoperative care, and others were caused by more exuberant inflammatory response associated with surgery on an immature eye or the intrinsic eyes abnormalities. Utilizing of advanced techniques and timely applying topical corticosteroids and cycloplegic agents can reduce the occurrence of visual axis opacification. Operation on children with strabismus or nystagmus, and applying occlusion therapy on amblyopic eyes can balance the visual inputs to the two eyes. Diagnosis of glaucoma following congenital cataract surgery requires lifelong surveillance and continuous assessment of the problem. So cataract surgeries in children are not the end of journey, but one step on the long road to visual rehabilitation. This paper describes recent evidence from the literature regarding the advance of management after congenital cataract surgery.
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21
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Leat SJ. To prescribe or not to prescribe? Guidelines for spectacle prescribing in infants and children. Clin Exp Optom 2011; 94:514-27. [PMID: 21722183 DOI: 10.1111/j.1444-0938.2011.00600.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This paper discusses the considerations for prescribing a refractive correction in infants and children up to and including school age, with reference to the current literature. The focus is on children who do not have other disorders, for example, binocular vision anomalies, such as strabismus, significant heterophoria or convergence excess. However, refractive amblyogenic factors are discussed, as is prescribing for refractive amblyopia. Based on this discussion, guidelines are proposed, which indicate when to prescribe spectacles and what amount of refractive error should be corrected. It may be argued that these are premature because there are many questions that remain unanswered and we do not have the quality of evidence that we would like; the clinician, however, must make decisions on whether and what to prescribe when examining a child. These guidelines are to aid clinicians in their current clinical decision making.
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Affiliation(s)
- Susan J Leat
- School of Optometry, University of Waterloo, Waterloo, Ontario, Canada. E‐mail:
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Milazzo S, Turut P, Brémond-Gignac D. [Infantile cataract and surgical management]. J Fr Ophtalmol 2011; 34:192-7. [PMID: 21377231 DOI: 10.1016/j.jfo.2011.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 12/29/2010] [Indexed: 11/25/2022]
Abstract
The cataract or opacification of the lens raises, in the child, two problems: of clinical diagnosis but especially of action to be taken therapeutic in particular surgical in front of a juvenille lens. This leads to a step and a therapeutic strategy, which must, individually, weigh the advantages and the disadvantages of the surgery. It is a frequent cause of visual handicap in the child. In the event of unilaterality, the major risks are the amblyopia and the aniseiconia. The elements to be analyzed are linked or the bilaterality, the type and the importance of opacity, local or general associated malformations, precocity diagnoses, and with regard to the treatment, the potential surgical complications, the quality of the optical correction, the postoperative assumption of responsibility and the cooperation of the parents. In all the cases, it will always be necessary to treat the functional part of the amblyopia.
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Affiliation(s)
- S Milazzo
- Clinique ophtalmologique Saint-Victor, 354, boulevard de Beauvillé, 80054 Amiens cedex 01, France.
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Tassignon MJ, Gobin L, De Veuster I, Godts D. [Advantages of the bag-in-the-lens intraocular lens in pediatric cataract surgery]. J Fr Ophtalmol 2009; 32:481-7. [PMID: 19717210 DOI: 10.1016/j.jfo.2009.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 06/26/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evaluate the advantages of the bag-in-the-lens intraocular lens in children undergoing cataract surgery. PATIENTS AND METHODS This prospective study included 54 eyes of 37 children and babies (age, 2 months to 14 years), consecutively operated on between December 1999 and January 2008 for unilateral or bilateral cataract using the "bag-in-the-lens" intraocular lens. Slit-lamp examination, intraocular pressure, visual acuity, and refraction were followed to the best possible degree over time. RESULTS The mean age of the 37 children at the last consultation visit was 8.3+/-4.9 years. The mean visual acuity improved from 0.2+/-0.1 to 0.8+/-0.3. On the other hand, visual acuity improvement in children presenting hyperplastic persistence of the vitreous was less favorable with a postoperative average visual acuity of 0.14+/-0.18. The mean postoperative refraction in 13 children (26 eyes) operated on for bilateral cataract was 0.5+/-1.5 D for eyes showing axial lengths with substantial variation. The refraction was stable over time in children over 2 years of age. Once the implant was positioned correctly, the remaining epithelial cells of the lens did not migrate toward the visual axis, which was the case in 93.8% of all eyes and in 100% of children over 1 year of age. CONCLUSIONS The "bag-in-the-lens" implant is particularly indicated in children in whom posterior rhexis and optic capture have been recommended since 1994. The implantation minimizes the use of anterior vitrectomy in pediatric cataract surgery, limiting it to those eyes presenting a proliferative hyperplastic vitreous.
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Affiliation(s)
- M-J Tassignon
- Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium.
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Hong S, Seong GJ, Kim SS. Posterior capsulectomy using a 25-gauge microincision vitrectomy system for preventing secondary opacification after congenital cataract surgery: outcome up to 4 years. Can J Ophthalmol 2009; 44:441-3. [DOI: 10.3129/i09-118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Bilateral uneven cataracts in children: amblyopia management by sequential intraocular lens implantation. Eye (Lond) 2009; 23:1451-5. [PMID: 19247388 DOI: 10.1038/eye.2009.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To report on amblyopia management of children with bilateral uneven cataracts treated by sequential intraocular lens implantation. METHODS Children with bilateral uneven cataracts who needed bilateral cataract surgery were prospectively enrolled in Oxford Eye Center, Johannesburg, South Africa and Southwest Eye Hospital, Chong Qing, China. In the same patient, the amblyopic eye with the denser cataract underwent primary intraocular lens implantation, whereas the better eye was temporarily left aphakic as an alternative to patching. A secondary intraocular lens implantation was performed in the aphakic eye when best-corrected visual acuity in the amblyopic eye attained its best potential. RESULTS Thirteen children were included in this non-comparative study. Average age at surgery was 3.02+/-1.87 years with an average follow-up period of 9.35+/-5.23 years. In the amblyopic eyes, 10 out of 13 (77%) had less than 20/120 best-corrected visual acuity before amblyopia treatment. The optical penalization of the dominant eye (temporary aphakia) lasted on average 8.38+/-4.05 weeks. The best-corrected visual acuity of the amblyopic eye improved to 20/50 or better in six eyes (46%), and ranged from 20/60 to 20/200 in five eyes (38%); in remaining two eyes, the best-corrected visual acuity stayed below 20/200. Best-corrected visual acuity was restored to 20/30 or better following intraocular lens implantations in 12 of the dominant eyes (92%). CONCLUSIONS Optical penalization by temporary aphakia of the dominant eye is a convenient means for treating amblyopia in children with bilateral uneven cataracts.
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Kuhli-Hattenbach C, Lüchtenberg M, Kohnen T, Hattenbach LO. Risk factors for complications after congenital cataract surgery without intraocular lens implantation in the first 18 months of life. Am J Ophthalmol 2008; 146:1-7. [PMID: 18407241 DOI: 10.1016/j.ajo.2008.02.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Revised: 02/10/2008] [Accepted: 02/14/2008] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine individual risk factors for the development of postoperative complications after pediatric cataract surgery in the first 18 months of life. DESIGN Interventional, consecutive case series. METHODS We retrospectively reviewed the records of 71 eyes of 46 children who underwent surgery for congenital cataract within the first 18 months of life. A limbal approach bimanual lens aspiration, posterior capsulorrhexis, and anterior vitrectomy without intraocular lens implantation was performed in all children. We examined the interrelationships of operative and postoperative complications with other variables such as patient age, family history, or ocular abnormalities. The mean follow-up period was 39 months. RESULTS The most frequent postoperative complications were late-onset open-angle glaucoma (10.8%) and vitreous hemorrhage (10.8%), whereas early-onset glaucoma (4.6%) was less common. Secondary cataract was observed in seven eyes (9.2%). We determined a family history of aphakic glaucoma in first-degree relatives (P = .007) as well as cataract surgery in the first three months of life (P = .039) and nuclear cataracts (P = .0009) to be strong predictors of late-onset glaucoma. Secondary cataract formation was associated strongly with lensectomy in the first five months of life. The diagnosis of postoperative hemorrhages was associated significantly with the presence of persistent fetal vasculature (P < .0001). CONCLUSIONS Patients with preoperative predictors at presentation such as young age at the time of surgery, a family history of aphakic glaucoma, nuclear cataract, or persistent fetal vasculature syndrome offer a clear target for extensive postoperative care after congenital cataract surgery.
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Affiliation(s)
- Claudia Kuhli-Hattenbach
- Department of Ophthalmology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
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Abdelwahab MT, Kugelberg M, Zetterström C. Irrigation with thapsigargin and various concentrations of 5-fluorouracil in a sealed-capsule irrigation device in young rabbit eyes to prevent after-cataract. Eye (Lond) 2008; 22:1508-13. [DOI: 10.1038/eye.2008.92] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Kim DH, Kim JH, Kim SJ, Yu YS. Clinical Results of Secondary Intraocular Lens Implantation in Bilateral Congenital Cataract. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.11.1752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dong Hyun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Young Suk Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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