Factors Associated with Strabismus after Cataract Extraction and Primary Intraocular Lense Implantation in Congenital Cataracts

Sang Hyun Kim; Wan Soo Kim; Soo Jung Lee

doi:10.3341/jkos.2011.52.3.325

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Kim, Kim, and Lee: Factors Associated with Strabismus after Cataract Extraction and Primary Intraocular Lense Implantation in Congenital Cataracts

Original Article

J Korean Ophthalmol Soc 2011;52(3):325-331.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.3.325

Factors Associated with Strabismus after Cataract Extraction and Primary Intraocular Lense Implantation in Congenital Cataracts

Sang Hyun Kim, MD¹, Wan Soo Kim, MD, PhD², Soo Jung Lee, MD, PhD²

¹Department of Ophthalmology, Maryknoll Hospital, Busan, Korea

²Department of Ophthalmology, Haeundae Paek Hospital, Busan, Korea

Address reprint requests to Soo Jung Lee, MD, PhD Department of Ophthalmology, Haeundae Paik Hospital #1435 Jwa-dong, Haeundae-gu, Busan 612-030, Korea Tel: 82-51-797-0100, Fax: 82-51-462-3534, E-mail: kris9352@hanmail.net

Received 6 January 201010 November 2010 Accepted 25 January 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate factors associated with the development of strabismus after cataract extraction and primary intraocular lens implantation.

Methods

Medical records of 80 patients who had undergone cataract extraction with primary intraocular lens implantation between 6 months and 21 years of age from March 1993 to March 2008 were reviewed. Nine patients (11 eyes) with strabismus before cataract surgery were excluded. Patients were divided into 2 groups; patients with congenital bilateral cataracts (43 patients, 86 eyes) or patients with unilateral cataracts (28 patients, 28 eyes). Data were collected on age at cataract surgery, pre and post-cataract extraction visual acuity, interocular visual acuity differences, nystagmus, operation method, and the existence of associated other ocular diseases to evaluate the association of the onset of strabismus and after cataract.

Results

Factors statistically significantly associated with the development of strabismus include presence of nystagmus in bilateral cataracts and postoperative visual acuity differences > 0.3 in unilateral cataracts. A post-cataract extraction mean visual acuity ≤ 0.2 and preservation of posterior capsule were significant factors in both groups.

Conclusions

Children with congenital cataracts should be monitored carefully after cataract surgery for the development of strabismus especially when they have poor postoperative visual acuity, nystagmus, large postoperative interocular visual acuity differences, or preservation of posterior capsule.

Keywords: Congenital cataract, Nystagmus, Posterior capsule, Strabismus, Visual acuity

References

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Table 1.

Patients characteristics with congenital cataracts

	Bilateral catar act (n = 43)		^∗ p-value	Bilateral catar ract (n = 28)		^∗ p-value
Male : female	16 : 19	5 : 3		16 : 4	4 : 4
Mean age at surgery	6.8 ± 4.7	3.9 ± 2.4	0.400	6.2 ± 3.5	1.1 ± 0.3	0.004
(mean±SD, yr)	(range, 1.3‐19)	(range, 0.5‐6)		(range, 0.5‐15)	(range, 0.7‐1.4)
Followup period	3.3 ± 2.7	3.0 ± 2.7	0.821	2.8 ± 3.8	2.4 ± 3.1	0.667
(mean±SD, yr)	(range, 0.5‐12)	(range, 1.3‐7)		(range, 0.5‐15)	(range, 0.5‐7)

^∗ Mann-Whitney analysis.

Table 2.

Associations of age at surgery with postoperative onset of strabismus

Age at surgery (yr)	Bilateral cataract (n = 43)		Unilateral cataract (n = 28)
Age at surgery (yr)	Postoperative orthotropia (n = 35)	Postoperative strabismus (n = 8)	Postoperative orthotropia (n = 20)	Postoperative strabismus (n = 8)
≤ 1	2	2	0	2
>1	33	6	20	6
^∗ p-value	0.151		0.074

^∗ Fisher's exact test.

Table 3.

Associations of preoperative mean visual acuity with postoperative onset of strabismus

	Bilateraal cataract (n = 43)		^∗ p-value	Unilateral cataract (n = 28)		^∗ p-value
	Postoperative orthotropia (n = 35)	Postoperative strabismus (n = 8)	^∗ p-value	Postoperative orthotropia (n = 20)	Postoperative strabismus (n = 8)	^∗ p-value
≤ 0.2	8	3		7	2
0.2 ≤ 0.5	12	1		4	2
0.5 ≤ 0.8	5	0		0	0
>0.8	1	0		0	0
≤ 0.2	8	3 (27.3%)	0.126	7	2 (22.2%)	0.538
>0.2	18	1 (5.3%)	0.126	4	2 (33.3%)	0.538
F & F poor	0	0		0	0
F & F well	0	2		0	0
Unable to measur	e 9	2		9	4

F & F = fix and follow.

^∗ Fisher's exact test.

Table 4.

Associations of preoperative visual acuity difference between fellow eyes with postoperative onset of strabismus

	Bilateral cataract (n = 43)		^∗ p-value	Unilateral cataract (n = 28)		^∗ p-value
	Postoperative orthotropia (n = 35)	Postoperative strabismus (n = 8)	^∗ p-value	Postoperative orthotropia (n = 20)	Postoperative strabismus (n = 8)	^∗ p-value
≤ 0.3	23	3		3	3
0.3 ≤ 0.5	2	1		3	1
0.5 ≤ 0.8	1	0		2	0
>0.8	0	0		3	0
≤ 0.3>0.3	23 3	3 (11.5%) 1 (25.0%)	0.454	3 8	3 (50.0%) 1 (11.1%)	0.143
Unable to measur	e 9	4		9	4

^∗ Fisher's exact test.

Table 5.

Associations of postoperative mean visual acuity with postoperative onset of strabismus

	Bilateral cataract (n = 43)		^∗ p-value	Unilateral cataract (n = 28)		^∗ p-value
	Postoperative orthotropia (n = 35)	Postoperative strabismus (n = 8)	^∗ p-value	Postoperative orthotropia (n = 20)	Postoperative strabismus (n = 8)	^∗ p-value
≤ 0.2	2	4		1	6
0. 2 ≤ 0.5	5	2		4	2
0.5 ≤ 0.8	6	0		7	0
0. 8 ≤ 1.0	16	2		4	0
>1.0	5	0		3	0
≤ 0.2	2	4 (66.7%)	0.013	1	6 (85.7%)	0.001
>0.2	32	4 (11.1%)	0.013	18	2 (10%)	0.001
Unable to measur	re 1	0		1	0

^∗ Fisher's exact test.

Table 6.

Associations of postoperative visual acuity difference between fellow eyes with postoperative onset of strabismus

	Bilateral cataract (n = 43)		^∗ p-value	Unilateral cataract (n = 28)		^∗ p-value
	Postoperative orthotropia (n = 35)	Postoperative onset of strabismus (n = 8)	^∗ p-value	Postoperative orthotropia (n = 20)	Postoperative onset of strabismus (n = 8)	^∗ p-value
≤ 0.1	31	6		12	1
0.1 ≤ 0.3	2	2		4	0
0.3 ≤ 0.5	1	0		1	4
0.5 ≤ 0.8	0	0		1	0
>0.8	0	0		1	3
≤ 0.3	33	8 (19.5%)	0.810	16	1 (5.9%)	0.001
>0.3	1	0 (0%)	0.810	3	7 (70%)	0.001
Unable to measure	1	0		1	0

^∗ Fisher's exact test.

Table 7.

Associations of nystagmus with postoperative onset of strabismus in bilateral cataracts

	Postoperative orthotropia (n = 35)	Postoperative strabismus (n = 8)
Nystagmus (+)	3	6 (66%)
Nystagmus (−)	32	2 (6%)
^∗ p-value	<0.001

^∗ Fisher's exact test.

Table 8.

Associations of removal of posterior capsule, other ocular disease, and posterior capsular opacity with postoperative onset of strabismus

	Bilateral cataract (n = 43)		^∗ p-value	Unilateral cataract (n = 28)		^∗ p-value
	Postoperative orthotropia (n = 35)	Postoperative strabismus (n = 8)	^∗ p-value	Postoperative orthotropia (n = 20)	Postoperative strabismus (n = 8)	^∗ p-value
Removed posterior capsule	30	3 (9.1%)	0.010	18	2 (10%)	0.002
Intact posterior capsule	5	5 (50%)	0.010	2	6 (75%)	0.002
Presence of other ocular disease	4	2 (33.3%)	0.308	5	3 (38%)	0.651
Absence of other ocular disease	31	6 (18.8%)	0.308	15	5 (25%)	0.651
Posterior capsular opacity (+)	7	2 (22.2%)	0.754	5	3 (37.5%)	0.651
Posterior capsular opacity (−)	28	6 (17.6%)	0.754	15	5 (25%)	0.651

^∗ Fisher's exact test.

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