Children Undergoing Cataract Surgery Research Articles

Intracameral Anaesthetic Mydriatic Versus Topical Mydriasis in Pediatric Cataract Surgery: A Randomized Control Study

To compare pupil dynamics after using premixed intracameral anesthetic mydriatic combination (ICAM) of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) versus topical mydriatic (TM) drops consisting of tropicamide 0.8%, phenylephrine 5%, and cyclopentolate 0.5% in pediatric cataract surgery. Randomized, masked, fellow eye-controlled trial. Tertiary eye care facility. Children ≤12 years of age with bilateral cataracts planned for surgery. One eye was randomized to receive ICAM and the other eye (control) TM drops. Commercially available ICAM that was injected at the beginning of surgery or TM 3 times at an interval of 30 minutes, 1 hour before the scheduled time of surgery. The other treatment was administered for the second eye cataract surgery. Pupil dynamics at various points of surgery were studied by a masked observer. Sixty-three patients (126 eyes) were randomized to receive ICAM in 1 eye (group 1) or TM drops (group 2). The mean age of the children in the study was 15.7 ± 24.3 months (range 3 months to 5 years). Adequate mydriasis with a single injection was achieved in 93.5% of patients in group 1 and 88.8% of patients in group 2 without additional pharmacotherapy or intervention. The mean pupillary diameter increased from 1.78 mm to 5.1 mm after injection of 1 unit of ICAM and from 1.75 mm to 6.06 mm with TM drops (P < .0001). The maximum pupillary dilation achieved was 6.06 ± 1.17 mm in group 1 and 6.75 ± 1.07 mm in group 2 (P = .004). The average change in pupillary size from injection of drug until the end of surgery was positive in group 1 (0.75 ± 0.98 mm) and negative in group 2 (-0.3348 ± 2.57 mm), ie, there was a relative miosis in group 2 toward the end of surgery (P = .001). Topical drugs achieved a larger maximum pupil size compared with ICAM. However, ICAM provided adequate and stable mydriasis without the need for augmentation compared with topical drops in children undergoing cataract surgery.

Comparing glaucoma risk in children receiving low-dose and high-dose glucocorticoid treatment after cataract surgery.

Treatment with glucocorticoids following paediatric cataract surgery is crucial to prevent inflammation, but may lead to secondary glaucoma, and hypothalamic-pituitary-adrenal axis suppression. We wish to compare glaucoma outcomes following high-dose and low-dose glucocorticoid treatment after paediatric cataract surgery. This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low-dose or high-dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High-dose treatment included 0.5-1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6-8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low-dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups. Overall, 267 children (388 eyes) were included in the study. Ninety-five children (133 eyes) had received high-dose treatment and had a median follow-up time of 89 months (IQR: 57.2-107.4), while 173 children (255 eyes) had received the low-dose treatment and had a median follow-up time of 40.5 months (IQR: 22.9-60.4). Survival curves showed a lower risk of glaucoma in the low-dose group for children with axial lengths ≥18 mm. Low-dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High-dose glucocorticoid should be limited in children undergoing cataract surgery.

Optic Capture Without Anterior Vitrectomy in Pediatric Cataract Surgery

To compare outcomes of 2 surgical techniques in children undergoing cataract surgery with intraocular lens (IOL) implantation: optic capture of IOL without anterior vitrectomy (AV) or in-the-bag IOL with AV. Prospective randomized controlled trial. Patients were randomized to 2 groups: optic capture without AV (group 1) or in-the-bag implantation with AV (group 2). The following variables were compared: visual axis opacification (VAO), inflammatory deposits on IOL surface, anteroposterior synechia, IOL tilt and decentration, lenticular astigmatism, refractive prediction error, and posterior segment complications. Fifty-one eyes of 37 children were investigated with a mean follow-up of 20.1±8.5 months. Group 1 and group 2 had mean ages of 59.2±32.6 and 46.5±21.9 months, respectively (P=.104). Three eyes in group 1 and 2 eyes in group 2 developed VAO (P=.656). Two eyes in group 1 and 5 eyes in group 2 developed anteroposterior synechia (P=.291). Six eyes in group 1 and 11 eyes in group 2 had inflammatory deposits on the IOL (P=.233). Both groups had similar IOL tilt and decentralization (for all meridians, P > .05). The absolute refractive prediction error was 0.55±0.34 diopter (D) and 0.53±0.3 D, respectively (P=.294). Each group had 1 eye with intraocular hypertension (P=.932). The optic capture method was similar to the conventional technique in the quantitative evaluation of comprehensive data such as visual axis opacification, inflammatory sequelae, refractive outcomes, and IOL stability. The optic capture technique is an appealing option for pediatric cataract surgery because it eliminates the requirement for vitrectomy.

Systemic and ocular associations in pediatric patients undergoing cataract surgery.

Evaluation for systemic diagnosis is an important part of pediatric cataract management. While there are reports on associated systemic and ocular associations in children with infantile cataracts, reports specifying associations in large cohorts of children undergoing cataract surgery are lacking. Retrospective chart review of consecutive patients undergoing cataract surgery at a pediatric tertiary referral center during 30-year period was performed. Associated systemic and ocular associations were recorded. The etiologies were analyzed depending on laterality, age, and gender. Seven-hundred twenty-seven patients (1135 eyes) were included for analysis: 408 (56%) with bilateral and 319 (44%) with unilateral cataract. An identifiable cause for cataract was identified in 66% (270/408) bilateral and 55% (176/319) unilateral cataract patients. Hereditary cataract accounted for 22% of bilateral cataracts. An underlying syndrome or genetic diagnosis was found in 24% bilateral (97/408, 86 genetic/syndromic, 11 metabolic) but only in 2% of unilateral cases (5/319). Cataracts were the result of treatment for cancer, or other systemic conditions requiring steroids, in 60/408 bilateral (15%) and 15/319 (5%) unilateral cataract patients. In contrast, unilateral cataracts had higher ocular associations (49%, 156/319) than bilateral cataracts (6%, 23/408) primarily ocular trauma (20%, 64/319) and persistent fetal vasculature (20%, 62/319). Clinicians should be aware of potential systemic and ocular associations among children with visually significant cataracts. Those with no family history of juvenile cataract should be evaluated for systemic associations, and referral to genetics may be warranted in select cases.

Aged Lens Epithelial Cells Suppress Proliferation and Epithelial-Mesenchymal Transition-Relevance for Posterior Capsule Opacification.

Posterior capsule opacification (PCO) is a frequent complication after cataract surgery, and advanced PCO requires YAG laser (Nd: YAG) capsulotomy, which often gives rise to more complications. Lens epithelial cell (LEC) proliferation and transformation (i.e., epithelial–mesenchymal transition (EMT)) are two critical elements in PCO initiation and progression pathogenesis. While PCO marginally impacts aged cataract surgery patients, PCO incidences are exceptionally high in infants and children undergoing cataract surgery. The gene expression of lens epithelial cell aging and its role in the discrepancy of PCO prevalence between young and older people have not been fully studied. Here, we conducted a comprehensive differentially expressed gene (DEG) analysis of a cell aging model by comparing the early and late passage FHL124 lens epithelial cells (LECs). In vitro, TGFβ2, cell treatment, and in vivo mouse cataract surgical models were used to validate our findings. We found that aged LECs decelerated rates of cell proliferation accompanied by dysregulation of cellular immune response and cell stress response. Surprisingly, we found that LECs systematically downregulated epithelial–mesenchymal transition (EMT)-promoting genes. The protein expression of several EMT hallmark genes, e.g., fibronectin, αSMA, and cadherin 11, were gradually decreased during LECs aging. We then confirmed these findings in vitro and found that aged LECs markedly alleviated TGFβ2-mediated EMT. Importantly, we explicitly confirmed the in vitro findings from the in vivo mouse cataract surgery studies. We propose that both the high proliferation rate and EMT-enriched young LECs phenotypic characteristics contribute to unusually high PCO incidence in infants and children.

Profile of Unilateral Cataract in Children With Congenital Rubella Syndrome

A congenital cataract is preventable blindness in children and is associated with intrauterine rubella infection known as congenital rubella syndrome (CRS), mostly found in developing countries. This study aims to describe the profile of unilateral cataracts in children with CRS, which are more difficult to manage than bilateral ones. As a retrospective study, we reviewed complete medical records of children with CRS and unilateral cataracts at Cipto Mangunkusumo hospital from 2017 to 2020. Fifteen patients were included, mostly male and from outside Jakarta.The mean age of onset was 2.9 months, while the average age at first presentation and surgery was 27.7 months and 29.1 months, respectively.No correlation was found between patients’ residential distance from the hospital towards duration between onset of symptoms and first presentation to the hospital. 100% and 66.7% of patients had leukocoria and microcornea as ocular manifestations. The majority of systemic manifestations are congenital heart disease.66.7% of children underwent cataract surgery without IOL implantation. Improvement of visual acuity postoperatively was observed in 13.3% of patients, and 66.7% of patients used contact lenses for visual rehabilitation. 60% of patients had posterior capsule opacity within six months of follow-up. The challenge of wearing contact lenses in children makes the risk of amblyopia even greater

Comparative Evaluation of Intraocular Lens Power Calculation Formulas in Children.

IntroductionWith the advent of newer microsurgical techniques, the results for cataract surgery have become quite promising. An accurate intraocular lens (IOL) power calculation is one of the most important factors in optimizing the results. The aim of this study was to evaluate the accuracy of four IOL power calculation formulas, namely, Barrett Universal II, Holladay 1, SRK/T and Hoffer Q, using optical biometry in children undergoing cataract surgery with primary IOL implantation.MethodsThis was a cross-sectional study. A total of 60 eyes of 42 children aged 5-16 years with congenital cataract and having undergone uneventful cataract surgery with IOL implantation were included in the study. Eyes were divided into three groups based on the axial length (AL): short (AL <22.00 mm), medium (AL 22-24.50 mm) and medium long (AL 24.50-26.00 mm). Optical biometry was used and the IOL power was calculated using the Barrett Universal II formula. The predicted postoperative refraction with the other three formulas, namely, SRK/T, Holladay 1 and Hoffer Q, using the same IOL power was estimated. This was compared with the actual postoperative refraction (spherical equivalent at 12 weeks) to give the absolute prediction error. The mean of all absolute prediction errors gave the mean absolute prediction error (MAE) values for each formula that were then compared.ResultsThe MAE was 0.64 ± 0.73 for Barrett Universal II, 0.7 ± 0.72 for Holladay 1, 0.71 ± 0.65 for Hoffer Q and 0.8 ± 0.75 for SRK/T. Thus, Barrett Universal II had the lowest MAE across the whole group. The difference in the MAEs was not statistically significant.ConclusionBarrett Universal II had the lowest MAE and thus was predictable for the highest number of eyes in our study, although this was not statistically significant (p=0.176).

Femtosecond laser-assisted anterior capsulotomy in children undergoing cataract surgery: a large case series

ObjectiveTo evaluate safety and postoperative visual outcomes of low-energy femtosecond laser-assisted (FLA) anterior capsulotomy in paediatric cataract surgery.Methods and analysisWe report a retrospective single-centre consecutive case series of 51 eyes...

Deviations From Age-Adjusted Normative Biometry Measures in Children Undergoing Cataract Surgery: Implications for Postoperative Target Refraction and IOL Power Selection

To evaluate whether pediatric eyes that deviate from age-adjusted normative biometry parameters predict variation in myopic shift after cataract surgery. This is a single institution longitudinal cohort study combining prospectively collected biometry data from normal eyes of children <10 years old with biometry data from eyes undergoing cataract surgery. Refractive data from patients with a minimum of 5 visits over ≥5 years of follow-up were used to calculate myopic shift and rate of refractive growth. Cataractous eyes that deviated from the middle quartiles of the age-adjusted normative values for axial length and keratometry were studied for variation in myopic shift and rate of refractive growth to 5 years and last follow-up visit. Multivariable analysis was performed to determine the association between myopic shift and rate of refractive growth and factors of age, sex, laterality, keratometry, axial length, intraocular lens power, and follow-up length. Normative values were derived from 100 eyes; there were 162 eyes in the cataract group with a median follow-up of 9.6 years (interquartile range: 7.3-12.2 years). The mean myopic shift ranged from 5.5 D (interquartile range: 6.3-3.5 D) for 0- to 2-year-olds to 1.0 D (interquartile range: 1.5-0.6 D) for 8- to 10-year-olds. Multivariable analysis showed that more myopic shift was associated with younger age (P < .001), lower keratometry (P=.01), and male gender (P=.027); greater rate of refractive growth was only associated with lower keratometry measures (P=.001). Age-based tables for intraocular lens power selection are useful, and modest adjustments can be considered for eyes with lower keratometry values than expected for age.

Suture Selection for Incision Closure in Pediatric Cataract Surgery: A Dilemma for Pediatric Ophthalmologists.

To measure and compare suture-related complications in children undergoing cataract surgery with a surgical incision closure performed by either a 10-0 nylon suture followed by suture removal within 1 to 2 weeks after surgery or a 10-0 polyglactin suture left in situ. This was a prospective, non-randomized cohort study. All children with bilateral cataracts who underwent cataract surgery with a surgical incision closure by non-absorbable 10-0 nylon sutures followed by suture removal within 1 to 2 weeks after surgery in their first eye and incision closure by absorbable 10-0 polyglactin sutures left in situ after their second eye surgery. The frequency of suture-related complications (vascularization near to suture, loosening of suture, mucus accumulation, early rupture, and infective keratitis) was noted for 10-0 nylon and 10-0 polyglactin sutures. Eighty-two eyes of 41 children were enrolled in the study. All children were observed until 3 months after surgery. Of the 10-0 nylon sutures, 2 (4.9%) were loose and 2 (4.9%) had underlying corneal edema. The remaining sutures (n = 37, 90.2%) were removed within 1 to 2 weeks after surgery. Of the 10-0 polyglactin sutures, 5 (12.2%) were loose, 2 (4.9%) were vascularized, and 3 (7.3%) had mucus infiltration. These sutures (n = 10, 24.3%) were removed 2 to 5 weeks after the second eye surgery. The remaining polyglactin sutures (n = 31, 75.6%) were left in situ. A higher frequency of suture-related complications was observed with the 10-0 polyglactin sutures than the 10-0 nylon sutures. The authors recommend using 10-0 nylon sutures with suture removal within 1 to 2 weeks after surgery over using 10-0 polyglactin sutures for incision closure in pediatric cataract surgeries. [J Pediatr Ophthalmol Strabismus. 2022;59(4):243-247.].

A GEE model for predicting axial length after cataract surgery in children younger than 2years of age.

To develop a model for predicting postoperative axial length (AL) in children undergoing cataract surgery younger than 2years of age. The Eye Hospital of Wenzhou Medical University, Hangzhou, China DESIGN: Retrospective study. Children were included only if AL data were available before surgery and at least 1year after surgery. Eyes were divided into pseudophakic, aphakic, and unaffected eye groups. Variables that could influence axial growth were analyzed and a multivariable generalized estimating equation regression model was developed to predict postoperative AL. 333 eyes from 190 patients were included. We observed a logarithmic linear correlation between age and AL in the unaffected eye group, AL = (2.7924 × log of age in months) + 17.607, R2 = 0.6596. Meanwhile, The GEE model of eyes with cataracts can be written as follows: Postoperative AL = 6.408 + 0.611 × (baseline AL) + 0.007 × (baseline age) - -0.006 (baseline age) × (age at follow-up) - -0.391 × coefficient of surgery. The ages were recorded in months, the ALs were recorded in millimeter. The assessment of AL is one of the most important parts of successful postoperative management in congenital cataract patients. This study established an AL estimate formula for children aged ≤ 2years with congenital cataract who underwent cataract surgery. This model theoretically could be used to predict individual future AL for child undergoing cataract surgery.

Evaluation of childhood cataract characteristics at a tertiary referral center.

To examine the epidemiological characteristics of children undergoing cataract surgery at a referral center in Sao Paulo State, Brazil, as well as the facts surrounding treatment delays. In this transversal observational study, 240 operated eyes from 178 children undergoing cataract surgery were reviewed. The following aspects were analyzed: epidemiological and clinical characteristics, parental observations, red reflex test, operated eye, and age at cataract diagnosis and surgery. The mean ages at the first visit and cataract surgery were 48.9 months (SD=50.0 months) and 64.5 months (SD= 55.4 months), respectively. The most critical sign adverted by parents was leukocoria. The red reflex test was performed on two-thirds of the children, with abnormal results in 28.0%. A family history of cataracts was evident in 30 (20,9%) children (n=144). Previous ocular surgery was found in 37 (16,6%) of the eyes (n=223), anterior segment disorders in 20 (9,0%) eyes (n=221), strabismus in 21 (9,5%) of the eyes (n=220), and nystagmus in 38 (24,4%) of the children (n=156). One of the causes for the delay in admission may have been the failure to complete the red reflex. In terms of etiology, heredity was the most crucial component. The presence of strabismus and nystagmus in many of these children points to late diagnosis. The most significant impediments to adequate cataract treatment in children were the lack of referral programs and children's specialized ophthalmologic centers, in addition to the restricted number of support professionals trained in the field and pediatric ophthalmology specialists.

Visual Outcomes Following Traumatic Cataract Surgery in Children in Mongolia: Experience Over 2 Years at a Major Hospital

Objective: To describe the demographics, nature of the injury and visual outcomes of pediatric patients presenting with traumatic cataract requiring surgery at the National Center for Maternal and Child Health in Mongolia and to compare the relevant literature on traumatic pediatric cataracts in other countries. Methods: The charts of individuals aged ≤ 18 years who underwent surgery for traumatic cataract over a two-year period at a pediatric hospital were reviewed. The data collected included: demographic information, mode and time of injury, intraocular lens type, surgeries pre- and post-operative best-corrected visual acuity, and surgical complications. Results: Over the 2-year study period, 27 children underwent cataract surgery for traumatic cataract. The mean age was 8.52 ± 4.7 years (range, 1-17 years). The type of primary insult was penetrating injury in over 80% of patients. The mean interval between injury and cataract surgery was 7 ± 6.5months. Pre-cataract surgery no patient had vision better than 20/40; after cataract surgery 36% had 20/50. Conclusion: A better understanding of the causes of eye injuries and the environments in which they occur can provide informed educated strategies for parents, caregivers, and teachers and can possibly reduce time to treatment.

The Role of Universal Newborn and Infant Physical Eye Examination Screening in the Detection of Congenital Cataract: Evidence from a Population Based Cohort Study

Background: In the United Kingdom, children should undergo eye examinations by maternity/neonatal teams or family practitioners within the first 72 post-natal hours, and again by eight weeks of age, to detect cataract. We report the frequency, associated factors and outcome of ‘late’ detection of congenital cataract in the UK. Methods: A population based prospective cohort study examining outcomes for children undergoing cataract surgery in the first two years of life, in 2009 and 2010. Detection of cataract after the age of eight weeks was defined as ‘late’. We used multivariable regression models to investigate factors associated with late detection. Findings: Of 186 babies, 64 (34%) with truly congenital cataract were diagnosed after 8 weeks of age. This late detection was independently associated with premature birth, specifically moderate and late preterm birth (adjusted odds ratio 3.0, 95%CI 1·1-8·5). The presence of co-existent globe anomaly was protective against late detection (adjOR 0·4, 95% CI 0·2-0·9). Outcomes at five years after surgery were 3- to 4-fold worse in those detected late. Interpretation: Delayed intervention in congenital cataract leads to life-long visual disability and consequent cumulative individual and societal burden. Our findings suggest that, despite a universal screening programme, one in three infants requiring surgery are not detected within the optimal period. Furthermore, there appears to be a gap in ascertainment of children born moderate to late preterm. It is necessary to improve the effectiveness of the screening programme, in particular in relation to pre-term children. Funding: Ulverscroft, Academy of Medical Sciences, NIHR. Declaration of Interest: None to declare. Ethical Approval: The study was approved by the ethics committees through the UK National Health Service Health Research Authority (Research ethics reference 08/H0714/65).

Accuracy of Intraocular Lens Power Calculation in Children With Vitrectomized Eyes Undergoing Cataract Surgery

Purpose: To assess the predictability of desired postoperative refractive outcomes using the SRK-II formula for intraocular lens (IOL) power calculation in children undergoing cataract surgery in eyes with a previous pars plana vitrectomy (PPV). Methods: In this retrospective study, 68 eyes of 66 children who underwent cataract surgery and IOL implantation in eyes that had previous vitrectomy between January 2008 and December 2017 were included. Data were collected on preoperative and postoperative characteristics. The Mann-Whitney test, Kruskal-Wallis test, and multinominal logistic regression were used for comparing the results. Results: Absolute prediction error (APE) in the cohort was 1.29 ± 1.13. Desirable refractive outcome with insignificant prediction error of less than 0.50 diopters (D) was found in approximately one-third of the children. Patients were further subdivided by magnitude of APE as ≥ 0.50 to ≤ 1.00 D and &gt; 1.00 D. Age at the time of surgery, axial length, mean keratometry, silicone oil removal, IOL position, scleral buckle, and corneal suture did not affect APE and there was no significant difference between the groups ( P &gt; .05). Conclusions: The mean APE of the SRK-II formula for IOL power calculation in pediatric eyes that had vitrectomy is comparable to that reported in the literature for routine pediatric cataract surgeries. Factors such as age, axial length, corneal power, IOL position (bag/sulcus), scleral buckle, corneal suture, and silicone oil removal done prior to surgery or along with cataract surgery did not affect the APE. [ J Pediatr Ophthalmol Strabismus . 2021;58(2):126–131.]

A sustained-release intracanalicular dexamethasone insert (Dextenza) for pediatric cataract surgery

We assess the outcomes of a sustained-release intracanalicular dexamethasone insert (Dextenza) in the treatment of postoperative ocular inflammation in children undergoing cataract surgery. Seventeen eyes of 17 children were analyzed. The anterior chamber was clear in 18% of eyes at 1-2weeks after surgery. A spike in intraocular pressure requiring intervention was observed in 18% of eyes. Rescue medications using topical steroids were required in 29% of eyes. Our initial experience suggests that the dexamethasone insert reduced or eliminated the need for postoperative steroid drops.

Prediction Errors and Accuracy of Intraocular Lens (IOL) Calculation Formulas in Pediatric Eyes

Background: Acquiring an accurate intraocular (IOL) power in children undergoing cataract surgery is challenging. Different IOL calculation formulas in children have been previously studied to achieve a precise prediction of the IOL power. Larger errors in IOL formula predictions have shown in several studies on children as future growth of the eye affects the keratometry readings and axial length. Prediction error (PE) and absolute prediction error (APE) can be effective indicators in assessing the accuracy of IOL power calculation formulas. Therefore, this review aims to investigate the accuracy of IOL power calculation formulas in pediatric eyes by measuring PE and/or APE value. Methods: A comprehensive search was conducted from various electronic databases (Pubmed, Clinical Key, and Ophthalmology Advance) using relevant search terms. Included studies were screened using predefined inclusion and exclusion criteria to identify comparative studies comparing the accuracy of IOL calculation formulas in pediatric patients. Result: Ten studies including 964 eyes were identified to compare different IOL formulas: Hoffer Q, SRK/T, SRK II, Holladay 1, and Holladay 2. Smaller prediction error is related to better postoperative refraction. Among included studies, Holladay 2 had the smallest mean prediction errors (PE), while SRK/T formula was the best formula of all included studies in pediatric patients as it had the smallest mean absolute prediction errors (APE). Hoffer Q also had the smallest mean APEs in shorter eyes (axial length &lt;22 mm). Conclusion: This study demonstrates that none of the established formulas found to be more superior than any other formulas in predicting IOL power in children. Biometry examination in patients with less than one year of age tends to show a lower accuracy.

Glaucoma following cataract surgery in the first 2 years of life: frequency, risk factors and outcomes from IoLunder2

BackgroundWe investigated glaucoma related adverse events, predictors and impact at 5 years following surgery in the IoLunder2 cohortMethodsPopulation based observational cohort study of children undergoing cataract surgery aged 2 years...

Secondary glaucoma and visual outcome after paediatric cataract surgery with primary bag-in-the-lens intraocular lens.

To determine predictors of secondary glaucoma and poor visual outcome in children undergoing cataract surgery with bag-in-the-lens (BIL)-IOL implantation. Medical records were retrospectively analysed for children with primary implantation with BIL-IOL during 2009-2013. The study included 109 eyes. Median age at surgery was 2.5years (range 2weeks-14.1years), 26.6% being ≤12weeks of age (=early group). Median follow-up time was 2.8years (7months-5.8years). 15 eyes (13.8%) developed glaucoma, 14 (48.3%) in the early group and 1 (1.3%) in the late group (p<0.001). Within the early group, mean time for surgery differed significantly. Patients developing glaucoma had cataract surgery at 3.5±1.1weeks (mean±SD) and the non-glaucoma patients at 5.7±3.3weeks (p=0.024). In the entire cohort, 21 eyes (19.3%) had conditions associated with glaucoma; 57.1% of these developed glaucoma compared to 3.4% without these conditions (p<0.001). Corrected distance visual acuity (CDVA) (decimal) of ≥0.5 was seen in 50 eyes (48.5%), median 0.63 in the late group and 0.15 in the early group. Glaucoma eyes in the early group (surgery at 3.5weeks) achieved 0.56 median (range, 0.4-1.0) logMAR, (0.28 decimal) CDVA, whereas non-glaucoma eyes (surgery at 5.7weeks) achieved 0.89 median (range 0.7-1.6) logMAR (0.13 decimal) CDVA; p=0.016. Glaucoma development in infants between 5weeks and 2years of age was 6.7% (n=2/30). Comorbidity strongly increases the risk of secondary glaucoma. Surgery during the first month is correlated with better CDVA outcome and glaucoma. After 5weeks of age, glaucoma rate is low with the BIL-IOL.

Digital biometry in children undergoing cataract surgery in vitrectomized eyes

Digital biometry in children undergoing cataract surgery in vitrectomized eyes