Abstract
AimThe aim of this study was to evaluate the long-term visual outcomes and factors affecting visual results in children undergoing secondary intraocular lens (IOL) implantation following primary congenital cataract extraction.MethodsChildren with congenital cataracts who underwent secondary IOL implantation for aphakia at the Eye and ENT Hospital of Fudan University between January 1, 2001, and December 31, 2007, were retrospectively reviewed. One eye was randomly selected in children with bilateral cataracts. Laterality, type of cataract (total or partial opacity), sex, age at primary and secondary surgeries, visual axis opacity (VAO), compliance with amblyopia therapy, postoperative ocular complications, refractive error, ocular alignment, and best corrected visual acuity (BCVA) at last follow-up were recorded; potential factors that might have affected the visual results were evaluated.ResultsSeventy-six bilateral and 34 unilateral congenital cataract cases were analyzed; the mean ages of the children were 12.70±5.06 and 12.50±2.71 years at final follow-up, the mean follow-up periods from IOL implantation were 94.93±24.22 and 109.09±18.89 months, and the mean BCVA (Log MAR) values were 0.51±0.37 and 1.05±0.46, respectively. Final BCVA after secondary IOL implantation was significantly associated with laterality, type of cataract, age at primary cataract extraction, compliance with amblyopia therapy, and refractive correction after surgery. No significant associations were found between BCVA and sex, age at secondary IOL implantation, VAO, or other ocular complications. The most common ocular complications were VAO and elevated intraocular pressure after surgery. There were no other complications, with the exception of one eye with IOL dislocation.ConclusionsThe results indicate that the important determinants of long-term visual outcomes in children with congenital cataracts undergoing secondary IOL implantation are laterality, cataract type, age at initial cataract extraction, compliance with amblyopia therapy, and refractive error.
Highlights
Congenital cataract, characterized by visual deprivation and formation of amblyopia, is an important, treatable cause of childhood visual handicap throughout the world [1]
Final best corrected visual acuity (BCVA) after secondary intraocular lens (IOL) implantation was significantly associated with laterality, type of cataract, age at primary cataract extraction, compliance with amblyopia therapy, and refractive correction after surgery
No significant associations were found between BCVA and sex, age at secondary IOL implantation, visual axis opacity (VAO), or other ocular complications
Summary
Congenital cataract, characterized by visual deprivation and formation of amblyopia, is an important, treatable cause of childhood visual handicap throughout the world [1]. Axial length increases rapidly until 2–3 years of age [4], and intraocular lens (IOL) implantation after cataract extraction is more susceptible to myopic shift in children under the age of 2 years. These children are more likely to suffer from intensive posterior capsule opacification (PCO) and excessive uveal inflammation [5,6]. Because IOL implantation in these children still remains controversial, primary cataract extraction is preferred in early detection cases, followed by spectacles or contact lenses to correct surgical aphakia, combined with management of amblyopia [7,8]. The goal of the current study was to investigate the long-term visual results of secondary IOL implantation in aphakic children over 2 years of age, as well as the potential factors affecting postoperative visual acuity
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