Children Undergoing Cataract Surgery Research Articles

Global Practice Patterns in the Management of Infantile Cataracts.

Surveys are an important tool to assess the impact of research on physicians' approach to patient care. This survey was conducted to assess current practice patterns in the management of infantile cataracts in light of the findings of the Infant Aphakia Treatment Study. Pediatric ophthalmologists were emailed a link to the survey using newsletters from American Association of Pediatric Ophthalmology and Strabismus, World Society of Pediatric Ophthalmology and Strabismus, and the Pediatric Listserv. The 17-question survey was anonymous and active during July to August 2016. One hundred twenty-five respondents (North America, 65%; Asia, 12%; Europe, 9%; and other, 14%) reported operating on pediatric cataracts. Most practice in a university setting (55%). There was a strong consensus that unilateral cataract surgery should be performed between ages 4 to 6 weeks and aphakic contact lenses should be used to optically correct their eyes, particularly in children ≤6 months of age. For bilateral cataracts, there was a trend for surgeons to perform cataract surgery at an older age than unilateral cataract surgery. Surgeons who performed less than 5 versus greater than 20 pediatric cataract surgeries/year were more likely to use aphakic contact lenses in children undergoing cataract surgery more than 6 months of age (62% vs. 35%, P=0.04). Most respondents (73%) indicated that the Infant Aphakia Treatment Study had changed how they manage unilateral congenital cataracts. Most pediatric cataract surgeons perform congenital cataract surgery between ages 4 to 6 weeks and use aphakic contact lenses for initial optical correction in infants less than 6 months. Surgeons have equal preference for intraocular lenses and contact lenses in infants more than 6 months of age.

Comparison of Two Methods of Wound Closure in Paediatric Cataract Surgery

Purpose: To compare the efficacy and outcome of viscosealing of incisions with suturing in pediatric cataract surgery. Methods: This prospective study was performed in children less than 5 years with congenital cataract who underwent phacoaspiration with primary posterior capsulorhexis and anterior vitrectomy with intraocular lens implantation at a tertiary care institute. Patients were divided into two groups. Group 1 included patients where 10-0 polyglactin (Vicryl) suture was used to close the sideports and main incision and in group 2 the incisions were sealed with 1.4% sodium hyaluronate. The patients were subsequently examined on serial follow up for one year. Results: 50 paediatric eyes undergoing phacoaspiration with intraocular lens implantation were included (25 in each group). Mean age at surgery was 10.65 ± 8.20 months in group 1 and 12.6 ± 9.57 months in Group 2. Complications encountered in group 1 were hyphema in 8 eyes, sideport synechiae in 4 eyes, iridolenticular adhesions in 12 eyes and vascularisation of the ports in 6 eyes post operatively. In group 2 synechiae at sideport was seen in 2 eyes, iridolenticular adhesions in 2 eyes, and shallow anterior chamber in 1 eye post operatively. Most of the complications in group 2 were seen in children <12 months of age (46.4%). Conclusion: Viscosealing is comparable to suturing of incisions in children undergoing cataract surgery. It avoids the suture related complications related to vascularization and hyphaema besides a second time general anesthesia needed to manage them.

Pediatric cataract surgery with hydrophilic acrylic intraocular lens implantation in Nepalese children.

PurposeTo assess the outcome of cataract surgery with hydrophilic acrylic intraocular lens (IOL) implantation in children with congenital and developmental cataracts.MethodA retrospective review of medical records of children with congenital or developmental cataracts who underwent cataract surgery with hydrophilic IOL implantation, from January 2011 to December 2014 in a tertiary eye hospital in Nepal. Primary posterior capsulotomy, anterior vitrectomy, and IOL implantation was done in children 8 years or younger, while older children underwent only lens aspiration and IOL implantation.ResultsA total of 178 eyes of 120 children underwent cataract surgery with primary IOL implantation. Mean age at the time of surgery was 6.9 years (range: 3 months to 15 years). Average follow-up time was 13.7 (±5.9) months. Associated ocular anomalies were present in 84 (47.1%) eyes. Postoperative complications were found in 33 eyes (18.13%) with inflammatory membrane being the most common (10.1%). Two eyes (1.1%) developed endophthalmitis. Second intervention was needed in 12 (6.5%) eyes. Preoperative vision of less than 6/60 was present in 105 eyes (57.69%). Final best corrected visual acuity of 6/12 or better was found in 81 (44.5%) eyes.ConclusionOur study shows that hydrophilic IOL is suitable for use in children. Results of this study are comparable with other studies on pediatric cataract surgeries using hydrophobic acrylic intraocular lenses. Low cost hydrophilic lens implantation is an effective approach in managing pediatric cataract surgery in developing countries like Nepal.

Cataract Surgery with Primary Lens Implantation in Children with Chronic Uveitis

ABSTRACTPurpose: To evaluate the evolution of chronic uveitis in children undergoing cataract surgery with primary intraocular lens (IOL) implantation.Methods: Twelve children with chronic uveitis underwent cataract surgery with primary posterior chamber intraocular lens (IOL) implantation.Results: Fourteen eyes were implanted with a foldable hydrophobic acrylic IOL. The mean follow-up was 35.39 months (8.72–69.57). The mean BCDVA before surgery and at the end of follow-up was 1.11 (0.40–2.30; SD: 0.57) and 0.48 (0–3; SD: 0.77; p=0.007) respectively. The mean oral corticosteroids dosage after surgery and at the end of follow-up was 0.80 mg/kg/day (SD: 0.37) and 0.17 mg/kg/day (SD: 0.24; p=0.001) respectively. All patients except one were treated with methotrexate. Four patients (5 eyes) were additionally treated with anti-tumor necrosis factor agent.Conclusions: Cataract surgery with primary posterior chamber hydrophobic IOL implantation is possible and leads to a good visual recovery in cases of pediatric chronic uveitis. This surgery requires aggressive anti-inflammatory management with immunosuppressive drugs to control inflammation and reduce the corticosteroids dosage.

Visual Outcome and Related Factors in Bilateral Total Congenital Cataract Patients: A Prospective Cohort Study.

This study is to evaluate the visual outcome and identify its crucial related factors in children undergoing cataract surgery for bilateral total congenital cataract (CC). This prospective study included consecutive bilateral total cataract patients undergoing primary surgery at Zhongshan Ophthalmic Center (ZOC), Guangzhou, China from Jan 2010 to May 2014. Visual outcome was estimated by best-corrected visual acuity (BCVA) at last follow-up. Potential related factors, including gender, age at last follow-up, age at primary surgery, surgical procedure, postoperative complications (PCs), frequency of follow-up and changes in spectacles were evaluated. Eighty-eight children (176 eyes) were included in the cohort. The mean post-operative BCVA (logMAR) was 1.07 ± 0.53 at the mean follow-up duration 31.07 ± 19.36 months. Multivariable generalized estimating equations (GEEs) showed BCVA was significantly associated with PCs, age at last follow-up and age at primary surgery. Partial correlation analysis indicated age at primary surgery was positively correlated with BCVA controlling for the other factors, both for the whole age range (R = 0.415, P < 0.001) and age >6 months (R = 0.867, P < 0.001). Better visual acuity was related to early primary surgery and low PC occurrence in children with bilateral total CC. Timely surgical intervention and strict control of PCs would be potential steps to achieving better visual outcome.

Pediatric cataract surgery with hydrophilic acrylic intraocular lens implantation in Nepalese children

Purpose To assess the outcome of cataract surgery with hydrophilic acrylic intraocular lens (IOL) implantation in children with congenital and developmental cataracts. Method A retrospective review of medical records of children with congenital or developmental cataracts who underwent cataract surgery with hydrophilic IOL implantation, from January 2011 to December 2014 in a tertiary eye hospital in Nepal. Primary posterior capsulotomy, anterior vitrectomy, and IOL implantation was done in children 8 years or younger, while older children underwent only lens aspiration and IOL implantation. Results A total of 178 eyes of 120 children underwent cataract surgery with primary IOL implantation. Mean age at the time of surgery was 6.9 years (range: 3 months to 15 years). Average follow-up time was 13.7 (±5.9) months. Associated ocular anomalies were present in 84 (47.1%) eyes. Postoperative complications were found in 33 eyes (18.13%) with inflammatory membrane being the most common (10.1%). Two eyes (1.1%) developed endophthalmitis. Second intervention was needed in 12 (6.5%) eyes. Preoperative vision of less than 6/60 was present in 105 eyes (57.69%). Final best corrected visual acuity of 6/12 or better was found in 81 (44.5%) eyes. Conclusion Our study shows that hydrophilic IOL is suitable for use in children. Results of this study are comparable with other studies on pediatric cataract surgeries using hydrophobic acrylic intraocular lenses. Low cost hydrophilic lens implantation is an effective approach in managing pediatric cataract surgery in developing countries like Nepal.

Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane

Study ObjectivesThis study aimed to test the hypothesis that premedication with a single dose of intranasal dexmedetomidine (DEX) could not only reduce preoperative anxiety but also minimize the emergence agitation in children undergoing cataract surgery with sevoflurane anesthesia. DesignSingle-blinded, randomized, placebo-controlled clinical comparison study. SettingAcademic medical center. PatientsNinety American Society of Anesthesiologists physical status 1 and 2 children scheduled for cataract surgery. InterventionsPatients were randomized into 3 groups: group D1, group D2, and saline group (group C), in which the children received 1 or 2 μg/kg of intranasal DEX or saline, respectively, and each group comprises 30 patients. MeasurementsThe mask induction score and the incidences of postoperative emergence agitation evaluated by the Pediatric Anesthesia Emergence Delirium scale were assessed. The emergence time, postanesthesia care unit (PACU) stay time, and any adverse events were recorded. Main ResultsThe mask induction scores were significantly higher in the saline group than those in the D1 and D2 groups (P<.001). The incidences of emergence agitation in the D1 and D2 groups were significantly lower than that in the saline group (7/30 in group D1 and 3/30 in group D2 vs 24/30 in group C, P<.001). The emergence time and PACU stay time were comparable among the 3 groups (P>.05). The emergence time and PACU stay time did not differ significantly in DEX-treated groups as compared with the saline group; there were no differences between 1- and 2-μg/kg groups. None of the patients exhibited significant clinical complications. ConclusionIntranasal DEX (1 or 2 μg/kg) dose independently improves the incidences of mask acceptance and prevents the incidences of postoperative emergency agitation mainly from sevoflurane without delaying the emergency time or inducing severe adverse events.

Effect of Low Dose Dexmedetomidine on Emergence Delirium and Recovery Profile following Sevoflurane Induction in Pediatric Cataract Surgeries

This randomized trial was conducted to assess the efficacy and recovery profile of low dose intravenous dexmedetomidine in prevention of post-sevoflurane emergence delirium in children undergoing cataract surgery. Sixty-three children aged 1–6 years were included. Anesthesia was induced with sevoflurane and airway was maintained with LMA. They were randomized to group D 0.15 (received intravenous dexmedetomidine 0.15 μg/kg), group D 0.3 (received dexmedetomidine 0.3 μg/kg), or group NS (received normal saline). The incidence of emergence delirium, intraoperative haemodynamic variables, Aldrete scoring, pain scoring, rescue medication, and discharge time were recorded. Emergence delirium was significantly reduced in dexmedetomidine treated groups with incidence being 10% in group D 0.15, none in group D 0.3, and 35% in the NS group (p=0.002). Significantly lower PAED scores were observed in D 0.15 and D 0.3 group compared to the NS group (p=0.004). Discharge time was significantly prolonged in the NS group compared to D 0.15 and D 0.3 (45.1 min ± 4.4 versus 36.8 min ± 3.8 versus 34.4 min ± 4.6), p&lt;0.02. Intravenous dexmedetomidine in low doses (0.3 and 0.15 μg/kg) was found to be effective in reducing emergence delirium in children undergoing unilateral cataract surgery.

Outcome of a New Acrylic Intraocular Lens Implantation in Pediatric Cataract.

To study the outcome of Hoya Clear Preloaded intraocular lens (IOL) (PC 60AD, AF Series; Hoya, Tokyo, Japan) implantation in children. Children who underwent phacoaspiration with primary posterior capsulotomy, anterior vitrectomy, and primary IOL implantation through a 2.8-mm incision were observed prospectively. In all cases, attempts were made to implant the IOL into the capsular bag. Parameters noted were ease of implantation, synechiae formation, IOL deposits, decentration of IOL, visual axis obscuration, haptic compression, and ovalling of the rhexis. Intraoperative complications related to the IOL were also recorded. This series comprised 58 eyes of 38 patients with congenital/developmental cataract who underwent implantation of the Hoya IOL. Mean age of the patients was 3.27 ± 2.69 years (range: 3 months to 8 years) and mean follow-up was 24.5 ± 9.13 months. Visual axis obscuration occurred in 4 eyes, posterior synechiae in 5 eyes, IOL deposits in 6 eyes, haptic compression in 3 eyes, and IOL decentration in 1 eye. The data suggest that implantation of the Hoya IOL is a safe option in children undergoing cataract surgery.

Strabismus in infants following congenital cataract surgery.

This study aimed to determine the incidence and characteristics of strabismus following congenital cataract surgery in infants. Patients aged <12 months who underwent surgery for congenital cataract and were followed-up for ≥1 years were included. Patients that had strabismus prior to surgery were excluded. Data regarding gender, cataract laterality, morphology, and density, age at the time of cataract surgery, ocular motility post surgery, and the presence of nystagmus were retrospectively obtained from the patients' records. The study included 79 patients (48 male and 31 female). Unilateral surgery was performed in 14 of the patients, versus bilateral surgery in 65. Strabismus did not occur post surgery in 32 (40.5 %) of the patients (group 1), whereas 47 (59.5 %) (group 2) developed strabismus following surgery. The patients in group 1 were followed-up for a mean 50.7 ± 38.5 months, versus 50.3 ± 39 months in group 2. Mean age at the time of cataract surgery in groups 1 and 2 was 3.6 ± 1.9 years and 4.6 ± 3.2 months respectively. Mean duration of time between cataract surgery and the development of strabismus was 13.3 ± 13 months (range: 1-60 months). Unilateral cases were more prone to develop strabismus, which was statistically significant (p = 0.028). Age at the time of cataract surgery, gender, cataract density, the occurrence of aphakic glaucoma, the presence of nystagmus, and additional ocular surgery were not significantly associated with the development of strabismus. Strabismus develops more frequently in children undergoing cataract surgery. In the present study strabismus occurred in more of the patients that underwent unilateral surgery. Based on the present findings, we think that long-term careful follow-up to monitor the development of strabismus is required in all infants undergoing cataract surgery, especially unilateral cases.

Effectiveness and safety of low-dose vecuronium on globe position of pediatric patients in ocular surgery

To test the effectiveness and safety of low-dose vecuronium (0.01 mg/kg) for correcting eccentric eye position during ocular surgery. A total of 80 ASA I-II children undergoing cataract or squint surgery were randomized into 2 groups (n = 40 each). Fentanyl and propofol were used for induction and then laryngeal mask (LMA) was inserted. 0.01 mg/kg vecuronium was administered to the low-dose group (L group) and 0.08 mg/kg vecuronium for high-dose group (H group). The ToF-Watch was fixed to monitor the train of four ratio (TOFR) of adductor pollicis. Eyeball eccentricity ratio before and after dosing, TOFR, duration of eyeball in central position, duration of surgery, the time from the end of surgery to removal of LMA and oculist satisfaction were recorded. The incidence of eccentric eyeball position was nearly 100% in both groups. The eyeball eccentricity ratio was 0.30 ± 0.11 in L group and 0.29 ± 0.12 in H group (P = 0.852) after/before vecuronium injection. The eyeballs were fixed well in the central position in both groups after vecuronium injection. The duration was shorter in L group than that in H group (23.43 ± 2.45 vs 37.63 ± 7.75 min, P < 0.001) . The time from the end of surgery to removal of LMA was (8.57 ± 3.49) min in L group and (12.28 ± 4.26) min in H group (P = 0.014). TOFR had merely mild reduction in L group and returned to normal in 10 minutes. At the end of surgery, TOFR was 102.43% ± 4.70% in L group and 80.47 ± 5.53 in H group (P < 0.001). Oculists were satisfied with eyeball position in both groups (P = 0.958). Low-dose vecuronium can correct eccentric eyeball position effectively and safely during ocular surgery while it has little effect on respiratory muscles.

Pediatric cataract: challenges and future directions.

Cataract is a significant cause of visual disability in the pediatric population worldwide and can significantly impact the neurobiological development of a child. Early diagnosis and prompt surgical intervention is critical to prevent irreversible amblyopia. Thorough ocular evaluation, including the onset, duration, and morphology of a cataract, is essential to determine the timing for surgical intervention. Detailed assessment of the general health of the child, preferably in conjunction with a pediatrician, is helpful to rule out any associated systemic condition. Although pediatric cataracts have a diverse etiology, with the majority being idiopathic, genetic counseling and molecular testing should be undertaken with the help of a genetic counselor and/or geneticist in cases of hereditary cataracts. Advancement in surgical techniques and methods of optical rehabilitation has substantially improved the functional and anatomic outcomes of pediatric cataract surgeries in recent years. However, the phenomenon of refractive growth and the process of emmetropization have continued to puzzle pediatric ophthalmologists and highlight the need for future prospective studies. Posterior capsule opacification and secondary glaucoma are still the major postoperative complications necessitating long-term surveillance in children undergoing cataract surgery early in life. Successful management of pediatric cataracts depends on individualized care and experienced teamwork. We reviewed the etiology, preoperative evaluation including biometry, choice of intraocular lens, surgical techniques, and recent developments in the field of childhood cataract.

Nursing care of the laryngeal mask airway in pediatric cataract surgery.

To investigate the important experience of nursing care of the laryngeal mask airway (LMA) in children undergoing cataract surgery. Fifty-five children undergoing cataract surgery were anesthetized by inhaling sevoflurane through a LMA and received perioperative nursing care. The safety of perioperative nursing for these children was also evaluated. Through perioperative nursing care and psychological counseling for children with LMA, all patients were anesthetized without complications and underwent successful surgeries. No severe postoperative complications were observed. Nursing care specific for LMA is a vital part of the success of anesthesia and pediatric cataract surgery.

Postoperative emergence delirium in pediatric patients undergoing cataract surgery – a comparison of desflurane and sevoflurane

Desflurane and sevoflurane are associated with postoperative emergence delirium (ED) in children. The study aimed to compare the use of desflurane and sevoflurane to determine the postoperative ED in children undergoing cataract surgery using the validated Pediatric Anesthesia Emergence Delirium (PAED) scale. In this randomized double-blinded study, 88 children of American Society of Anesthesiologists (ASA) grade I and II aged 2-6years, anesthesia was maintained with 1-1.2 MAC concentration of desflurane or sevoflurane after induction with sevoflurane. Subtenon block was administered in all children with 0.08-0.10ml·kg(-1) of 0.5% bupivacaine before surgical incision. Primary outcome measured was PAED scale at different time intervals between the two groups, and secondary outcome measured was preoperative anxiety scores, postoperative pain scores, emergence, incidence of delirium and adverse effects. Pediatric Anesthesia Emergence Delirium (PAED) scale showed no statistical difference between sevoflurane and desflurane at different time intervals. Incidence of ED using the cutoff of >12 in PAED scale was 8 of 44 (18.18%) in sevoflurane group and 9 of 44 (20.45%) in desflurane groups (P=1.000). Emergence from anesthesia was faster in desflurane group (P=0.001). Correlation between the m-YPAS anxiety scale and PAED scale in either group did not find any relationship (correlation coefficient=-0.060, P=0.579). No correlation between the Face, Legs, Activity, Cry and Consolability (FLACC) scale and Pediatric Anesthesia Emergence Delirium (PAED) scale was found in 17 patients who had ED (correlation coefficient=0.191, P-value=0.462). Five patients of 17 (i.e., three patients in Group S and two patients in Group D) had PAED >12 but FLACC <4. Emergence delirium (ED) after desflurane and sevoflurane anesthesia was comparable using a validated PAED scale in pediatric cataract surgery. There was no correlation between preoperative anxiety and ED in these children; however, children with higher pain scores were more likely to have a higher ED.

Corneal Endothelial Cell Characteristics After Pediatric Cataract Surgery

To describe the corneal endothelial cell characteristics after pediatric cataract surgery. Retrospective case series of 29 study eyes and 26 controls were evaluable. Specular microscopy was performed and endothelial cell features were correlated with clinical and surgical features. Mean age at testing was 106 months in the study group and 116 months in the control group with a mean interval of 78 months after cataract surgery. Mean endothelial cell density in study eyes was 2,668 cells/mm(2) (control eyes, 3,002 cells/mm(2), P < .01). Mean coefficient of variation was 35% (control eyes, 31%, P < .01), and mean percentage of hexagonal cells was 40% (control eyes, 51%, P < .01). There was no significant difference based on age, duration since cataract surgery, contact lens use, glaucoma, number of intraocular procedures, or presence of intraocular lens. This study demonstrates endothelial cell loss with polymegathism and pleomorphism in children undergoing cataract surgery. This poses a risk of developing long-term corneal complications and hence close monitoring of the endothelial cell count is advisable.

Parental comprehension following informed consent for pediatric cataract surgery

ObjectiveTo investigate the effectiveness of information transfer by the pediatric cataract surgeon to the parents or guardians of children during the informed-consent process. DesignProspective observational case series. ParticipantsParents of 31 children undergoing cataract surgery. MethodsParents were enrolled from the clinical practice of 1 pediatric cataract surgeon. Using a checklist developed in consultation with other pediatric cataract surgeons, the surgeon discussed the nature of the disease, the course without surgical intervention, the surgical procedure, the risks and benefits, and the postoperative care. Immediately after the discussion, parents were invited to complete a questionnaire assessing information recall. Analysis of variance and the t test were used to determine associations between questionnaire scores and demographic variables. The surgeon subsequently called parents and discussed again the issues that they had not remembered correctly, as identified by the questionnaire responses. The study and data accumulation were carried out with the approval of the Research Ethics Board at The Hospital for Sick Children, Toronto, Ont. Informed consent for the research was obtained from the parents or legal guardians of the children enrolled in the study. The study adhered to the tenets of the Declaration of Helsinki. ResultsOf 31 parents, 18 (58%) overestimated their understanding of the informed-consent discussion. Parents scored well on questions about the nature of the disease and the postoperative follow-up but scored lower on questions regarding surgical risks and outcomes. Parents identified several barriers to understanding, including the large amount of information, stress, and preoccupation with the child. No association was noted between the level of understanding and demographic factors. ConclusionsParents may overestimate their understanding of informed-consent discussions. Some parents may be overly optimistic about risks and outcomes. The surgeon's follow-up communication with parents that addressed aspects insufficiently understood during the initial discussion provided a way of improving comprehension.

Effects of Clonidine on Recovery after Sevoflurane Anaesthesia in Children Undergoing Cataract Surgery

This trial assessed the effects of two doses of clonidine compared with placebo on the quality and speed of recovery in children premedicated with oral midazolam and anaesthetised with sevoflurane for cataract surgery. One hundred and twenty American Society of Anesthesiologists physical status I to II children (aged one to six years), premedicated with oral midazolam 0.5 mg/kg and undergoing elective unilateral cataract surgery with sevoflurane anaesthesia were studied. Children were randomised to intravenous clonidine 1 microg/kg (group C1, n=39), 2 microg/kg (group C2, n=41) or normal saline (group NS, n=40). Clinically successful sub-Tenon local anaesthesia block was required for a patient to be included in the analysis. The primary outcome was the incidence of postoperative agitation. Postoperative agitation was defined as a Pain Discomfort Score of -3 using items 3 to 5 only, which was assessed 15 minutely until discharge. Agitation was observed in 11/40 (27.5%) children in the NS group compared to 2/39 (5.1%) in group Cl and none in group C2 (P < 0.001). Rescue medication to treat severe agitation was required in 5/40 (12.5%) in the NS group, 1/39 (2.6%) in group C1 and none in group C2 (P = 0.025). Time to meet discharge criteria was significantly shorter in group C1 compared to the other two groups (48.4 +/- 14.0 minutes compared to C2 79.5 +/- 12.8 minutes and NS 73.1 +/- 20.4 minutes, P < 0.001). There were no significant effects on blood pressure and heart rate. Intravenous clonidine 1 microg/kg is effective for reducing agitation after sevoflurane anaesthesia and midazolam premedication in children undergoing cataract surgery. Intravenous clonidine 2 microg/kg was also effective and for a longer period, but was associated with a longer time to discharge.

The incidence of glaucoma following paediatric cataract surgery: a 20-year retrospective study

To analyse the incidence of glaucoma in children undergoing cataract surgery and determine whether early surgery is associated with increased risk of glaucoma. A retrospective chart review of all children aged 14 years or less who had surgery for congenital or developmental cataract at one unit over the last 20 years. The children were divided into three groups; group 1 consisting of children aged < or =50 days at surgery, group 2 those aged 51 days to 1 year, and group 3 aged 1-14 years. We identified a total of 104 eyes of 74 children. The medical records for 100 eyes (71 children) were available for review. In all, 17 eyes (12 children) were aged < or =50 days at surgery, none of which have developed glaucoma. Group 2 consisted of 28 eyes (17 children) with one patient developing glaucoma in both eyes 11 years after surgery. Group 3 consisted of 55 eyes (42 children), none of which have developed glaucoma. After a median follow-up period of 4.9 years (range 0.6-19.6 years, mean 6.4 +/- 5.2 years) 2% of eyes had developed glaucoma. There was no significant difference in the length of follow-up between groups (H=2.979, P=0.22, Kruskal-Wallis Test). There was a low incidence of glaucoma in our series and this was not increased in those having surgery in the first 6 weeks of life. Our findings contribute further evidence for the variability in prevalence of glaucoma after paediatric cataract extraction in the literature and suggest that factors other than age at surgery are important risk factors for this condition.

The value of serial personal photographs in timing the onset of unilateral cataracts in children

To determine the value of serial personal photographs in timing the onset of unilateral cataracts in children over 6 months of age. Personal photographs from children with unilateral cataracts who underwent cataract extraction and intraocular lens implantation when > or =6 months of age were reviewed. Photographs were evaluated for changes in the red reflex, which might indicate the presence of a cataract. Twelve children underwent cataract surgery at a mean age of 37 months. They were followed for a mean of 32 months. Ten children were diagnosed as having an acquired cataract by photographic review documenting a previously normal red reflex. The visual acuity in the affected eye of 4 of these children improved to > or =20/60. Cataracts were visible on photographs prior to clinical diagnosis in 6 patients, from 0.5 to 22 months prior to clinical diagnosis. Visual outcomes did not relate closely to the photographically documented duration of the cataract prior to treatment. Photographs were not helpful in timing the onset of cataract in 2 children due to the poor quality of the images. Serial personal photographs are sometimes helpful in determining whether cataracts are acquired. However, the usefulness of personal photographs alone in predicting the visual outcome after cataract surgery was limited in this small, retrospective study.

Intérêt de l’implant « bag-in-the-lens » dans la chirurgie de la cataracte de l’enfant

Evaluate the advantages of the bag-in-the-lens intraocular lens in children undergoing cataract surgery. This prospective study included 54 eyes of 37 children and babies (age, 2 months to 14 years), consecutively operated on between December 1999 and January 2008 for unilateral or bilateral cataract using the "bag-in-the-lens" intraocular lens. Slit-lamp examination, intraocular pressure, visual acuity, and refraction were followed to the best possible degree over time. The mean age of the 37 children at the last consultation visit was 8.3+/-4.9 years. The mean visual acuity improved from 0.2+/-0.1 to 0.8+/-0.3. On the other hand, visual acuity improvement in children presenting hyperplastic persistence of the vitreous was less favorable with a postoperative average visual acuity of 0.14+/-0.18. The mean postoperative refraction in 13 children (26 eyes) operated on for bilateral cataract was 0.5+/-1.5 D for eyes showing axial lengths with substantial variation. The refraction was stable over time in children over 2 years of age. Once the implant was positioned correctly, the remaining epithelial cells of the lens did not migrate toward the visual axis, which was the case in 93.8% of all eyes and in 100% of children over 1 year of age. The "bag-in-the-lens" implant is particularly indicated in children in whom posterior rhexis and optic capture have been recommended since 1994. The implantation minimizes the use of anterior vitrectomy in pediatric cataract surgery, limiting it to those eyes presenting a proliferative hyperplastic vitreous.