Long-term outcome of bilateral surgery in infant with congenital cataract using different approaches

Abstract

Objective: To explore the best surgical approach for infant with congenital cataract by comparing long-term follow-up results of bilateral congenital cataract surgery by different approaches conducted during infant age at last time of visit. Methods: This retrospective case control study includes 108 eyes of 54 infants with bilateral congenital cataract who received bilateral cataract triple procedure (vitrector lensectomy, posterior capsulotomy and anterior vitrectomy) performed by a single surgeon, by either anterior or posterior approach, followed by refractive correction by aphakic glasses or intraocular lens (if suitable)during the follow-up periods (at least for 3 years), between January 2002 and February 2013 in Department of Ophthalmology, Peking University People's Hospital. The unilateral and bilateral best corrected visual acuity (BCVA), intraocular pressure, anterior segment and fundus exam of each visit and post-operative complications were evaluated, and data collected at patients' last visit were compared between two approaches (Student's t test for continuous variables, chi-squeare test for constitutional variables). Results: A total of 44 cases (33 males) were included in anterior approach group, median age of primary surgery was 3.0 (0.5-10.0) months. The rest 10 cases (7 males) were included in the posterior approach group, median age of primary surgery was 4.0 (1.0-11.0) months. At last visit, longest follow up period of anterior and posterior group were 3.5 (3.0-8.5) years and 4.0 (3.0-7.0) years, respectively. Neither unilateral nor bilateral BCVA (logarithm of minimum angle of resolution) of both anterior and posterior approach groups at last visit showed any difference(both P>0.05).Long-term post-operation complications of anterior and posterior group include strabismus (8 cases and 2 cases), nystagmus(8 cases and 6 cases), optical opaque (4 cases and 2 cases), and ocular hypertension(2 cases and 1 case). Nystagmus (P<0.001) and optical opaque (P=0.041) was more prevalent in posterior approach group. Conclusion: For bilateral congenital cataract surgery during infant age, anterior approach would produce less post-operation complications as compared to posterior approach, and is recommended for infants without other abnormalities of posterior segment of the eye. (Chin J Ophthalmol, 2019, 55:46-50).