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Abstract
Purpose
To evaluate the long-term visual outcomes of secondary posterior chamber intraocular lens implantation after 2 years of age for bilateral congenital cataract.
Methods
A retrospective case review was conducted of 42 pediatric patients who were diagnosed with bilateral congenital cataract and underwent irrigation and aspiration of lenses, posterior capsulectomy, anterior vitrectomy, and after two years of age secondary posterior chamber intraocular lens implantation.
Results
The median age at irrigation and aspiration of the lens was 21 weeks; the median age at secondary intraocular lens implantation was 5.5 years; the median age at the last follow-up was 11.1 years. The final visual acuities were 0.42 in the better eye and 0.23 in the fellow eye. The median refractive error at the final follow-up was -2.5 diopters of spherical equivalent, and 1.2 diopters in the amount of astigmatism. For all cases, no posterior capsule opacification, intraocular lens dislocation, or retinal detachment was found. There were 16 postoperative glaucoma patients (19.0%), and their intraocular pressures were well controlled with medical therapy.
Conclusions
Secondary posterior chamber intraocular lens implantation performed after two years of age can be an effective therapy for visual development in patients with bilateral congenital cataract undergoing irrigation and aspiration of the lens, posterior capsulectomy, anterior vitrectomy, and aphakic spectacle correction.
References
1. Vasavada AR, Nihalani BR. Pediatric cataract surgery. Curr Opin Ophthalmol. 2006; 17:54–61.
2. Yu YS, Kim SJ, Chang BL. Cataract surgery in children with and without retinopathy of prematurity. J Cataract Refract Surg. 2004; 30:89–94.
3. Park JH, Yu YS, Kim JH, et al. Visual Function after Primary Posterior Chamber Intraocular Lens Implantation in Pediatric Unilateral Cataract: Stereopsis and Visual Acuity. Korean J Ophthalmol. 2007; 21:195–200.
4. Trivedi RH, Wilson ME Jr, Facciani J. Secondary intraocular lens implantation for pediatric aphakia. J AAPOS. 2005; 9:346–52.
5. Kim HY, Yu YS. Effect of posterior chamber intraocular lens implantation on unilateral cataract. J Korean Ophthalmol Soc. 1997; 38:788–95.
6. Kim HY, Lee YJ, Yu YS. Treatment and prognosis of cataract in children. J Korean Ophthalmol Soc. 1998; 39:1544–51.
7. Parks MM. Visual results in aphakic children. Am J Ophthalmol. 1982; 94:441–9.
8. Cheng KP, Hiles DA, Biglan AW, Pettapiece MC. Visual results after early surgical treatment of unilateral congenital cataracts. Ophthalmology. 1991; 98:903–10.
9. Birch EE, Stager DR. Prevalence of good visual acuity following surgery for congenital unilateral cataract. Arch Ophthalmol. 1988; 106:40–3.
10. Drummond GT, Scott WE, Keech RV. Management of monocular congenital cataracts. Arch Ophthalmol. 1989; 107:45–51.
11. Birch EE, Swanson WH, Stager DR, et al. Outcome after very early treatment of dense congenital unilateral cataract. Invest Ophthalmol Vis Sci. 1993; 34:3687–99.
12. Kugelberg U. Visual acuity following treatment of bilateral congenital cataracts. Doc Ophthalmol. 1992; 82:211–5.
13. Birch EE, Stager DR. The critical period for surgical treatment of dense congenital unilateral cataract. Invest Ophthalmol Vis Sci. 1996; 37:1532–8.
14. Bradford GM, Keech RV, Scott WE. Factors affecting visual outcome after surgery for bilateral congenital cataracts. Am J Ophthalmol. 1994; 117:58–64.
15. Yamamoto M, Dogru M, Nakamura M, et al. Visual function following congenital cataract surgery. Jpn J Ophthalmol. 1998; 42:411–6.
16. Kushner BJ. Visual results after surgery for monocular juvenile cataracts of undetermined onset. Am J Ophthalmol. 1986; 102:468–72.
17. Seaber JH, Buckley EG. Functional outcome of monocular and binocular congenital cataract. Part I: visual acuity. Am Orthopt J. 1997; 47:29–46.
18. Lambert SR, Drack AV. Infantile cataracts. Surv Ophthalmol. 1996; 40:427–55.
19. Baker JD. Visual rehabilitation of aphakic children: II. contact lenses. Surv Ophthalmol. 1990; 34:366–71.
20. Hiles DA. Visual acuities of monocular IOL and non-IOL aphakic children. Ophthalmology. 1981; 88:1296–300.
21. Wright KW, Spiegel PH. Pediatric Ophthalmology and Strabismus, 2nd ed. New York: Springer-Verlag,. 2003; 450–80.
22. Ye HH, Deng D, Qian YY, et al. Long-term visual outcome of dense bilateral congenital cataract. Chin Med J. 2007; 120:1494–7.
23. Lundvall A, Kugelberg U. Outcome after treatment of congenital bilateral cataract. Acta Ophthalmol Scand. 2002; 80:593–7.
24. Gouws P, Hussin HM, Markham RH. Long term results of primary posterior chamber intraocular lens implantation for congenital cataract in the first year of life. Br J Ophthalmol. 2006; 90:975–8.
25. Lundvall A, Zetterström C. Primary intraocular lens implantation in infants: complications and visual results. J Cataract Refract Surg. 2006; 32:1672–7.
26. Zetterström C, Kugelberg M. Paediatric cataract surgery. Acta Ophthalmol Scand. 2007; 85:698–710.
27. Frezzotti R, Caporossi A, Mastrangelo D, et al. Pathogenesis of posterior capsular opacification. Part 2: histopathological and in vitro culture findings. J Cataract Refract Surg. 1990; 16:353–60.
28. Hosal BM, Biglan AW. Risk factor for secondary membrane formation after removal of pediatric cataract. J Cataract Refract Surg. 2002; 28:302–9.
29. Fenton S, O'Keefe M. Primary posterior capsulorhexis without anterior vitrectomy in pediatric cataract surgery: longer-term outcome. J Cataract Refract Surg. 1999; 25:763–7.
30. Simon JW, Mehta N, Simmons ST, et al. Glaucoma after pediatric lensectomy/vitrectomy. Ophthalmology. 1991; 98:670–4.
31. Johnson CP, Keech RV. Prevalence of glaucoma after surgery for PHPV and infantile cataracts. J Pediatr Ophthalmol Strabismus. 1996; 33:14–7.
32. Swamy BN, Billson F, Martin F, et al. Secondary glaucoma after paediatric cataract surgery. Br J Ophthalmol. 2007; 91:1627–30.
33. Keech RV, Tongue AC, Scott WE. Complications after surgery for congenital and infantile cataracts. Am J Ophthalmol. 1989; 108:136–41.
34. Asrani S, Freedman S, Hasselblad V, et al. Does primary intraocular lens implantation prevent "aphakic" glaucoma in children? J AAPOS. 2000; 4:33–9.
35. Dahan E, Drusedau MU. Choice of lens and dioptric power in pediatric pseudophakia. J Cataract Refract Surg. 1997; 23:S618–23.
36. Crouch ER, Crouch ER Jr, Pressman SH. Prospective analysis of pediatric pseudophakia: myopic shift and postoperative outcomes. J AAPOS. 2002; 6:277–82.
Figure 1.
Best corrected visual acuity in final follow-up of patients that was diagnosed with bilateral congenital cataract and underwent irrigation and aspiration of lens, posterior capsulectomy, anterior vitrectomy, secondary posterior chamber intraocular lens implantation after two years of age.
Figure 2.
Best corrected visual acuity in final follow up of patients that was diagnosed bilateral congenital cataract and underwent irrigation and aspiration of lens, posterior capsulectomy, anterior vitrectomy, secondary posterior chamber intraocular lens implantation after two years of age.
Table 1.
Patients' characteristics
| Sex | Male:Female=28:14 |
|---|---|
| Cause | Idiopathic:Hereditary=34:8 |
| Type Total opacity:Nuclear opacity:Cortical opacity=25:9:3 | |
Table 2.
Postoperative refraction error at 3 months of postoperative I&A of lens and PC-IOL insertion, final follow-up in bilateral congenital cataract patients
| Post I&A‡(Post Op 3 months) | SE*: +13.3D (+7.5D~+19D) |
|---|---|
| AST†: 0.57D (0D~2.5D) | |
| Post secondary PC§-IOL insertion | SE: +0.83D (+3.5D~-3.75D) |
| (Post Op 3 months) | AST: 0.81D (0D~4.5D) |
| Final follow-up | SE: -1.64D (+2.75D~-5.25D) |
| AST: 1.10D (0D~3.75D) |
Table 3.
Best corrected visual acuities at the final follow-up according to the time of I&A
| Time of I&A | Final BCVA (Snellen) |
|---|---|
| 6~12 weeks | 0.50 |
| 13~18 weeks | 0.47 |
| 19~24 weeks | 0.34 |
| 24 weeks~ | 0.33 |
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