Cataractes congénitales : correction de l’aphaquie par lentilles de contact rigides

Abstract

To describe follow-up and evaluate functional results of rigid gas-permeable contact lens wear for the correction of aphakia in infants after surgery for congenital cataract. This retrospective study was performed on 23 eyes of 17 children (12 boys and five girls), between three days and 36 months of age (median 3.5 months), undergoing cataract extraction without primary intraocular lens implantation and fitted only with Menicon(®) Z material contact lenses. Initial fitting visits included history and family education. Subsequent examinations were performed at eight days, 15 days, 1 month, 6 months and 1 year. The four main parameters studied were fit characteristics, ease of manipulation, ocular integrity and lens integrity. Concurrently, functional results (visual acuity, oculomotor balance) and various prognostic factors (associated pathology, age at time of surgery, cataract density, unilaterality versus bilaterality, postoperative complications) were evaluated. Rigorous systematic amblyopia rehabilitation was performed. At the one-month exam, 60% of parents demonstrated proficiency with manipulating the lens. On one-year follow-up, three cases of failure were attributable to difficulties with lens manipulation. At one year, one infectious complication was detected. The lens material demonstrated good resistance to breakage (9% at one month) and only a mild tendency toward deposits (few or no deposits in 95% of cases at 1 month). With regard to visual outcome, among the children old enough to cooperate, visual acuity was better than 3/10 for nine out of 12 eyes, of which five eyes were 10/10. With regard to alignment, we noted 12 cases (70.6%) of strabismus postoperatively (ten esotropia, two exotropia). The factors predictive of good visual acuity correlated with those described in the literature: partial cataract, bilateral cataract, and absence of postoperative oculomotor disturbance. The characteristics of rigid gas-permeable contact lenses provide safety and efficacy in aphakic infant eyes. They represent an attractive alternative to primary intraocular lens implantation in congenital cataract.