Congenital Cataract Extraction Research Articles

The Role of Corneal Aberrations in the Development and Progression of Pseudophakic Myopia after Congenital Cataract Extraction in Infancy

Relevance. Many studies have shown a relationship between higher order aberrations and refractive errors in children without comorbidities, but these studies have not been conducted in children with pseudophakia. Purpose. Evaluation of corneal aberrations after congenital cataract (CC) extraction with intraocular lens (IOL) implantation in infancy, and their impact on the dynamics of eye growth and myopia progression. Materials. Thirty-two children (the median age 9.35 ± 3.31 years; range 4–15 years) with pseudophakia were divided to: group 1, planned refraction (17 children, 23 eyes) and group 2, pseudophakic myopia (15 children, 23 eyes). Twelve children (24 eyes; the median age 11.67 ± 2.43 years) with moderate and high myopia without ophthalmic pathology were examined as a comparison group. Keratometry and aberrometry were performed on a Scheimpflug Galilei G2. Results. Total corneal aberrations root mean square (RMS) and higher order aberrations (HOA) were higher in pseudophakic children (2.77 and 1.13 µm in group 1, 2.48 and 1.15 µm in group 2) when compared with children with acquired myopia (1.58 and 0.44 µm; p < 0.05). Oblique astigmatism and negative oblique trefoil were the highest in pseudophakic myopia (0.63 and (-)0.48 µm). There were positive correlations between eye growth in 4 years and HOA (r = 0,699; p < 0,01), eye growth during the total follow-up time and oblique astigmatism (r = 0,393; p < 0,01), and negative correlation between eye growth during the total follow-up time and oblique trefoil (r = -0,322; p < 0,05). Conclusion. Corneal incision with forced corneal suture during surgery in infants leads to an increase in HOA, especially oblique astigmatism, and oblique trefoil. Correlations between corneal aberrations and the dynamics of globe axial length growth indicate the effect of monochromatic aberrations on eye growth already in the early postoperative period.

Prevalence of Glaucoma Following Paediatric Cataract Surgery in an Australian Tertiary Referral Centre.

Secondary glaucoma following childhood cataract surgery remains the most common complication in the paediatric population. This study aimed to determine the incidence, time to progression and risk factors associated with the development of secondary glaucoma following childhood cataract surgery in a paediatric population. Outcome measures were the detection of secondary glaucoma, postoperative time frame to development of glaucoma and risk factors in its development. A retrospective case series was conducted between 2003 and 2017 at a tertiary children's hospital in Sydney. The patient population included those 16 years or less of age who underwent congenital cataract extraction, with or without an intraocular lens implantation and who had been followed up for a minimum of six months following surgery. Patients were excluded if they had cataract aetiology other than congenital idiopathic cataract. Multivariate Cox Regression analysis was used to determine relevant risk factors. A total of 320 eyes in 216 patients were included in the study. Secondary glaucoma developed in 11.9% of eyes. In those that developed secondary glaucoma, the average time to onset from surgery was 3.2 years (median 2.75 years). The mean age of diagnosis of secondary glaucoma was 4.58 years (median 3.5 years, range 2.5 months to 13.23 years). Microcornea was the only adverse characteristic significantly associated with an increased risk of secondary glaucoma (HR 6.30, p 0.003). Despite modern surgical techniques, glaucoma remains a significant long-term sequela in children following cataract surgery.

Morphometric and functional features in children with pseudophakic myopia after congenital cataract extraction in infancy

AIM: To investigate the morphometric parameters of the macular zone in children with pseudophakia and different refractive states after congenital cataract extraction in infancy and their correlations with vision parameters.
 MATERIAL AND METHODS: Thirty children (49 eyes) who underwent bilateral cataract surgery with primary intraocular lens (IOL) implantation, with a median age at surgery of 7.942.70 (212) months, were identified. These children were divided into two groups: group 1 with target refraction (n=18, 21 eyes) and group 2 with pseudophakic myopia (n=14,28 eyes). All patients were examined with the Nidek RS-3000 Advance two optical coherence tomography.
 RESULTS: A significant reduction was found in the morphometric parameters in group 2 relative to that in group 1: foveal thickness (253.1127.84 and 266.4221.52 m), average inner macula thickness (307.6430.9 and 330.1428.29 m) and average outer macula thickness (281.1722.51 and 298.7828.23 m), central choroidal thickness (221.8779.04 and 311.9468.38 m), macular volume (7.990.71 and 8.760.49 mm3), and foveal volume (0.190.02 и 0,210.02 mm3). This can be due to axial elongation (24.722.18 and 21.281.55 mm). The correlation between the best-corrected visual acuity (BCVA) and macular volume was moderate in pseudophakic children (r=0.418; p 0.01).
 CONCLUSION: The data indicate an impairment of the macular zone formation in children with pseudophakic myopia which to a certain extent can explain the decrease in functional prognosis.

A comparative analysis of myopia development in children with bilateral and unilateral pseudophakia

After the extraction of congenital cataract in infancy, postoperative refraction changes differently in patients with bilateral and unilateral pseudophakia. Purpose: to compare myopia development in children with bilateral and unilateral pseudophakia. Material and methods. We examined 33 children (63 eyes) with bilateral and 21 children with unilateral pseudophakia for long-term results of congenital cataract extraction performed in their infancy, The evaluated parameters included the incidence and degree of myopia, refraction, general postsurgical astigmatism, and axial length of the eye. Refraction was measured by Nidek ARK-530A (Japan). The axial length was measured by ultrasound B-scan (Voluson E8, GE) or by optical biometry (AL-Scan, Nidek). Results. In bilateral pseudophakia, high myopia was detected if astigmatism was more than 3.25 D or oblique. In the latter case, the eyeball showed a greater growth as compared to with-the-rule astigmatism (4.67 mm and 3.26 mm, respectively; p < 0.05). With incomplete correction of astigmatism in the case of bilateral pseudophakia, myopia progressed to a high degree in nearly half of the cases (48.1 %), and a greater growth of the eye was detected compared with complete correction (4.45 mm and 3.42 mm respectively; p > 0.05). The type and degree of astigmatism did not affect the development and progression of myopia in unilateral pseudophakia. Conclusion. The effect of undercorrected astigmatic defocus on the development and progression of myopia in bilateral pseudophakia is apparently associated with a equivalent visual load on both eyes, while this load is significantly reduced in unilateral pseudophakia so that it fails to affect the development of myopia in such cases.

Prevalence of Congenital Cataract and Lens Extraction in Lahore Population

Congenital cataracts account for one-third of infant blindness globally and are one of the leading cause of vision loss in children. A retrospective study was performed between October 2020 and April 2021 on congenital cataract patients of Lahore visited ophthalmologic consultation at the Al Ehsaan eye hospital, General Hospital and Mayo hospital. The purpose of the study was to find the prevalence of congenital cataract in children. About 100 cases of congenital cataract including both male and female children were identified from age group of 1-13years. Congenital cataract was diagnosed using Snellen’s visual acuity test, ophthalmoscope and slit lamp test. Male children showed greater prevalence of congenital cataract as compared to female children. The prevalence of congenital cataract in male children was 55% (n=55) while among female children, it was 45% (n=45). Both conditions of unilateral and bilateral congenital cataract were observed with incidence of 46% (n=46) and 54% (n=54) in male and female children respectively. Lens extraction was also done in 94% (n=94) and after surgery 55% (n=52) patients showed positive response and 45% (n=42) patient had negative response for light perception. Moreover, most patients of congenital cataracts were of less than 1 year of age group. It was concluded congenital cataract may lead to childhood blindness if not treated on time.

Сase of congenital cataract development in a child with Farh disease

INTRODUCTION: Fahr disease is a rare idiopathic neurodegenerative disorder characterized by the calcification of the basal ganglia, cerebellar dentate nuclei, and surrounding white matter leading to progressive nervous system dysfunction. Cases of congenital cataracts are not described.
 AIM: To describe a clinical case of congenital cataract in a pediatric patient with Farh disease.
 MATERIAL AND METHODS: Congenital atypical progressive metabolic cataract was diagnosed in a 9-year-old child. Congenital cataract extraction with intraocular lens implantation was performed.
 RESULTS: Refraction before operation was sph+2.0 cyl+1.5 ax 107 and sph+0.25 cyl+1.25 ax 74, respectively. The preoperative visual acuity for both eyes was 0.5 log MAR and 1.0 log MAR, respectively. Crystalline lenses were cloudy with atypical star-shaped infusions. Full-field electroretinogram (ERG) a-wave and b-wave were normal for OD and abnormal for OS, and flicker ERG was normal for both eyes. Visually evoked potentials were prolonged for both eyes. The intraocular pressure was normal for both eyes. The axial lengths were 22.60 mm and 22.62 mm, respectively. Exudative reaction was noted postoperatively, and the logMar visual acuity improved to 0.2 for both eyes.
 CONCLUSION: Congenital cataracts may be diagnosed in patients with Fahr disease. Dynamic examination of the child with a wide pupil is necessary to identify initial changes in the lens and to refer him/her for surgical treatment. There is an increased risk of exudative reactions in the early postoperative period.

Результаты комплексного лечения обскурационной амблиопии у детей после экстракции врожденной катаракты

Purpose. To evaluate the dynamics of obscuration amblyopia complex treatment in children after congenital cataract lens extraction. Material and methods. We analyzed the case histories of 107 patients from the period of 2016 to 2020, who were diagnosed with congenital cataract, aged 3 to 14 years. There were 84 children (78.5%) with unilateral cataracts who underwent the surgery, and 23 children (21.5%) with bilateral cataracts. All patients were divided into two groups. The first group (main group) included 56 patients (69 eyes) with congenital cataracts, who underwent intraocular lens implantation with repeated pleopto-orthoptic treatment in the postoperative period. The average age was 4.68±2.91 years. Control group included 51 patients (61 eyes) with congenital cataracts who underwent phacoemulsification of congenital cataracts with implantation of an intraocular lens without pleopto-orthoptic treatment in the postoperative period. The average age was 4.81±2.79 years. Results. By the end of the follow-up period, an increase in visual acuity to 0.2 and higher in patients of the main group was noted in 73.9% of cases (51 eyes), in the control group – in 44.3% of cases (27 eyes) (p<0.05). As a result of treatment, central fixation was restored in 38% of patients in the main group, in 20% of patients in the control group (p<0.05). Binocular near vision was developed in 34% of patients in the main group, in 18% of patients in the control group (p<0.05). Conclusion. Complex treatment, including regular pleoptoorthoptic treatment in combination with optical correction, direct occlusion after congenital cataract extraction, demonstrated positive clinical results, which was expressed in an increase of visual acuity, restoration of central fixation, and the development of binocular vision. Key words: obscuration amblyopia, congenital cataract, pleopto-orthoptic treatment, visual functions

Clinical and functional characteristics of pseudophakic myopia in children after congenital cataract extraction in infancy

One of the serious challenges facing surgeons after congenital cataract extraction with IOL implantation in infancy is unplanned refractive results revealed in the long-term period, including the cases of myopia higher than 3.0 D in approximately 50 %. Purpose. The study aimed to evaluate the clinical and functional condition of the eyes in children with moderate to high myopia. Material and methods. Our study included a total of 33 patients (61 eyes) with pseudophakia, of which 16 (26 eyes) developed moderate (12 eyes) or high (14 eyes) myopia at the age of 5 to 15 years. Parameters of the anterior and posterior eye segments were evaluated using Galilei Dual Scheimpflug Analyzer and Optical Coherence Tomography RS-3000 Advance 2, and the axial length using Optical Biometer Al-Scan. Results. The central corneal thickness (CCT) was found considerably above the norm (up to 580 ± 35 pm) in most cases of pseudophakic myopia (72.2 %). Anterior chamber depth in children (4.07 ± 0.39 mm) was equal to that in adults with pseudophakia. Astigmatism and axial length in children with highmyopia significantly exceeded those in children with moderate myopia (3.5 and 1.88 D; 23.57 ± 1.31 and 25.04 ± 1.90 mm, respectively), while choroidal thickness and best corrected visual acuity (BCVA) were much lower (268 and 181 pm; 0.1 and 0.3, respectively). There were no variations in spherical equivalent between different axial length in high and moderate myopia. Conclusion. Taken together these results suggest that with the increase of astigmatism axial length elongated and high myopia developed in children with pseudophakia. Choroidal thickness declined due this process and may be a cause of poor functional outcome. Sufficient CCT opens possibilities for refractive surgery in those patients to improve visual outcomes.

• TITLE: Comparison of intracameral injection with subconjunctival injection of dexamethasone for postoperative inflammation in congenital cataracts

ABSTRACT:
 Introduction: Cataract affects a huge population around the globe and equally affects Pakistani population. Children with congenital cataract presents with huge deformity and dependence, the consequences are lifelong if not treated with better management at right time. In this study we aimed at comparing intracameral and subcojunctival injection of dexamethasone in congenital cataract in terms of postoperative inflammation.
 Purpose: The purpose of our study is comparing the role of intracameral injection with subconjunctival injection of dexamethasone in preventing immediate postoperative inflammation after congenital cataract extraction and to make the ground for better option for programmatic implementation in these cases.
 Study Design: Randomized control trial
 Place and duration of study: Holy Family Hospital, Rawalpindi since june 2014 to May 2015.
 Material and methods: In this RCT, 190 children with congenital cataract were enrolled in the department of ophthalmology, Holy Family Hospital, Rawalpindi. Patients were selected using a random table, 95 cases each in intracameral injection and subconjunctival injection of dexamethasone groups.The study duration was one year from june 2014 to May 2015. Ethical approval was granted by hospital ethics committee and patients were administered a written informed consent at enrolment. The outcome measure was intraocular inflammation after surgery for extraction of cataract.
 Results: Male cases were in majority in group B (58.9%) whereas in group A females (55.8%) were in majority. Mean age was6.43 ± 4.69 years in Group-A compared to 5.85 ± 4.10 years in Group-B. Frequency of posterior synechiae (inflammation) was 4.21% (n=4) in Group-A (intracameral) compared to 15.79% (n=15) in Group-B (subconjunctival) which was significantly different (p-value, 0.007).
 Conclusion: Intracameral injection is better than subjunctival injection of dexamethasone in the management of post-operative inflammation in children with congenital cataract.

Soemmering Ring Eclipse

A 30-year-old woman presented for evaluation of a lesion in the left eye. She underwent congenital cataract extraction in the left eye without lens replacement at 6 months of age. She denied prior trauma or pain. Best-corrected visual acuity was 20/20 in the right eye and 20/150 in the left eye, which was reportedly stable. Slit-lamp examination revealed a dome-shaped, pigmented mass eclipsing the pupil from the posterior nasal iris (Panel A). Fundus examination and intraocular

Primary intraocular lens implantation can be applied in infants over 7 months of age and young children with adequate consideration

In recent years, intraocular lenses (IOLs) have been increasingly used in the correction of aphakia after congenital cataract extraction. But IOL implantation in infants and young children, especially under 1 year old, is still controversy. Large-scale, multi-center, randomly controlled clinical observations on this issue have been conducted. The mid-and long-term results have shown that infantile cataract extraction combined with primary IOL implantation can achieve the same or better visual outcome as aphakic contact lens correction. For infants over 7 months of age and young children, primary implantation of IOLs is relatively safe, with a low complication and secondary operation rate. Compared to the way of aphakic contact lens correction, which could be with more inconvenience, high demand of coordination, a higher infection risk, high cost and the need of a secondary IOL implantation surgery, primary implantation of IOLs at over 7 months of age is worth exploring, with appropriate understanding of the surgical indications and adequate surgical techniques. (Chin J Ophthalmol, 2021, 57: 487-491).

Comparative analysis of visual outcomes of multifocal and monofocal intraocular lenses in congenital cataract surgery.

To assess the impact on visual development of multifocal vs monofocal intraocular lenses (IOLs) implantation in children after congenital cataract surgery. Ophthalmology Department, Bambino Gesù Children's Hospital, Rome, Italy. Retrospective interventional consecutive case series. Records of 56 eyes of 43 pediatric patients who underwent congenital cataract surgery with phacoaspiration and simultaneous implantation of the IOL younger than 1 year were reviewed. Corrected distance visual acuity (CDVA), refractive error, and ocular motility disorders were evaluated at follow-up of greater than 4 years. 32 multifocal (18 unilateral, Group A and 14 bilateral, Group B) and 24 monofocal (12 unilateral, Group C and 12 bilateral, Group D) IOLs were implanted. Mean follow-up was 6.67 years. Mean CDVA of the eyes with multifocal IOLs was 0.75 ± 0.46 logMAR in unilateral cataract surgery and 0.34 ± 0.25 logMAR in bilateral ones; with monofocal IOLs was 0.71 ± 0.52 logMAR in unilateral and 0.53 ± 0.43 logMAR in bilateral ones. No statistically significant difference in the CDVA between Groups A and B and Groups C and D were recorded. Final mean spherical equivalent was -3.88 ± 4.73 diopters (D); in Group A, it was -2.74 ± 4.22 D, in Group C was -1.08 ± 1.45 D, in Group B was -4.82 ± 4.64 D, and in Group D was -6.81 ± 4.61 D. The difference was statistically significant between Groups B and D (P = .01), but not between Groups A and C (P = .14). 26 patients (60.4%) showed postoperative strabismus. Surgical correction occurred more in patients with multifocal IOLs implanted (P = .038). Multifocal IOLs did not show significant advantages in visual development in children after congenital cataract extraction younger than 1 year when compared with monofocal IOLs.

Risk factors and prognosis of the development of pseudophakic myopia in children

Recent studies indicate the prevalence of myopic refraction in children with pseudophakia, which significantly reduces the functional results of treatment and may be an indication for replacing the intraocular lens (IOL). Therefore, studies conducted to achieve the target refraction in children with pseudophakia are relevant. Purpose To determine the risk factors for the prognosis of myopic refraction in children after extraction of congenital cataract and IOL implantation. Material and methods The study presents the results of refraction examination in 69 (110 eyes) children aged 1 to 12 years 36 months after extraction of congenital cataract with implantation of soft IOL. Results The obtained data of anamnesis, results of ophthalmological, echobiometric, clinical and laboratory studies were subjected to statistical processing assessing the significance of differences in outcomes depending on the impact of possible risk factors for the development of pseudophakic myopia; a regression logistic model and a ROC-curve were constructed. Conclusion According to the authors, reliable risk factors for the development of pseudophakic myopia in children can be such indicators as axial eye length at the time of IOL implantation exceeding the age norm by more than 0.2 mm; the child from the first pregnancy; the AL/CR ratio of ≥3.0; myopia on the paired eye; strabismus of more than 4 prism diopters; hereditary load; tension of eye's fibrous capsule: pressure of ≤180 mm Hg at the time of IOL implantation. The presented reliable factors, as well as a combination of less significant signs (the child being outside for less than 1 hour per day, intermarriage of the patient's parents, near-sight visual loads of more than 3 hours per day, the blood Ca level of less than 1.8 mmol/L) can be used for prognosis of the development of pseudophakic myopia and to help make adjustments in the management tactics for patients to achieve target refraction.

Evaluation of the Changes in Vessel Density and Retinal Thickness in Patients Who Underwent Unilateral Congenital Cataract Extraction by OCTA.

PurposeTo evaluate the changes in vessel density in patients with unilateral congenital cataract after cataract extraction.Materials and MethodsChildren with unilateral congenital cataract were enrolled in our study. All of the patients underwent congenital cataract extraction and intraocular lens (IOL) implantation successfully. Optical coherence tomography angiography (OCTA) was performed to image the retinal vasculature in the macular and optic disc areas before and after surgery. The differences in vessel density and retinal thickness between groups were compared.ResultsWe found that the best corrected visual acuity (BCVA) was significantly improved one month after surgery compared with that before surgery (t=5.179, p<0.001). The axial length was also changed one month after surgery (t=5.350, p<0.001). The vessel density in the macular and optic disc areas of the affected eyes was significantly lower than that in the normal eyes, while the vessel density at the posterior pole was significantly improved one month after cataract extraction.ConclusionThe decrease in vessel density in the macular and optic disc areas might be a consequence of the congenital cataract. Cataract extraction can relieve the form deprivation of the affected eye and increase the vessel density at the posterior pole of the affected eye significantly.

Changes in Intraocular Pressure and Anterior Chamber Angle After Congenital Cataract Extraction.

Anterior chamber angle (ACA) narrowing continues to occur for at least 2 years after congenital cataract surgery. Risk factors for intraocular pressure (IOP) elevation after congenital cataract surgery were higher central corneal thickness (CCT) and surgery at <2 months. The purpose of this study was to study the changes in IOP and in the ACA during the first 2 years after pediatric cataract surgery and to determine risk factors for such changes. A retrospective observational study was done on infants who underwent pediatric cataract surgery in Cairo University Hospitals and completed a 1-year follow-up. Demographic and clinical characteristics were recorded including age at surgery, sex, corneal diameter, CCT pupil diameter, IOP, gonioscopic findings, presence of persistent hyperplastic primary vitreous, surgical approach, primary intraocular lens implantation, and perioperative subconjunctival steroid injection. Changes in IOP and in the ACA were recorded, and the risk factors for such changes were analyzed. Postoperative IOP elevation >18 mm Hg occurred in 23 eyes of 206 eyes (11%), who completed Year 1 and in 9 (13%) of 86 eyes who completed Year 2. Risk factors for IOP elevation were larger preoperative CCT (P=0.01) in Year 1, and younger age at surgery (P=0.01), and aphakia (P=0.05) in Year 2. In multivariate analysis only younger age at surgery was a risk factor for IOP elevation in Year 2. ACA narrowing occurred in 49% and in 21% of the examined eyes in Years 1 and 2, respectively. Aphakia was not a significant risk factor of angle narrowing in Years 1 and 2 (P=0.17 and 0.42, respectively). Higher preoperative CCT was a risk factor for early-onset IOP elevation. Surgery at >2 months was associated with lower susceptibility to late-onset IOP elevation.

Indices of refraction in children with pseudophakia predisposed to abnormal refractive error changes after congenital cataract extraction

Purpose. To study refractive indices in children with a predisposition to myopia and hyperopia after congenital cataract extraction and IOL implantation. Material and methods . 60 children (95 eyes) aged 1 to 12 years were examined for refraction error 30–36 months after congenital cataract extraction and IOL implantation. The examination included case history data to find out whether the children were predisposed to myopia or hyperopia before IOL implantation. Results. Refraction increase in pseudophakia is observed both in and beyond the risk group. Myopia and emmetropia disproportionate to age were manifested in most children with a predisposition to myopia (70.2 %). The authors believe that abnormal refractive changes may be a result of inadequate selection of IOL optical power, explained by the fact that it is calculated by a universal formula irrespective of the risk of abnormal refraction changes in children and specific biometry in the risk group. The high frequency of unplanned refraction in case of pseudophakia in children predisposed to abnormal refractive changes is probably due to either obscuration and refractive amblyopia. Conclusion. In children at risk of abnormal refractive changes, it is advisable to determine an individual correction coefficient for the formula calculating IOL power prior to IOL implantation, to correct residual refraction and to treat amblyopia.

The choice of the optimal method for the extraction of congenital cataract, combined with high myopia

The choice of the optimal method for the extraction of congenital cataract, combined with high myopia

Binocular reading in children following extraction of a dense congenital or infantile unilateral cataract

Reading relies on ocular motor function, requiring sequential eye movements (forward and regressive saccades). Binocularly discordant input from a dense congenital or infantile cataract is associated with ocular motor dysfunction and may affect the development of reading ability. The purpose of this study was to assess silent, binocular reading in children treated for unilateral congenital or infantile cataract. Twenty school-age children (age range, 7-13years) treated for unilateral congenital (n=9) or infantile (n=11) cataract and 49 age-similar control children silently read a grade-appropriate paragraph during binocular viewing. Reading rate (words/min) and the number of forward and regressive saccades (per 100 words) were recorded using the ReadAlyzer. Reading rate in children treated for a unilateral cataract did not differ significantly from controls (174±59 words/min vs 195±54 words/min; P=0.1). However, they did have significantly more forward saccades (101±33 saccades/100 words vs 87±21 saccades/100 words; P=0.03) but not regressive saccades (21±14 saccades/100 words vs 16±8 saccades/100 words; P=0.1) compared with controls. Reading rate was not related to cataract type (congenital vs infantile), visual acuity outcome (poor vs good), or sensory fusion (fail vs pass; all P≥0.1). Reading rate of children treated for a dense unilateral cataract did not differ from that of controls. Increased forward saccades during reading may be due to fixation instability associated with fusion maldevelopment nystagmus prevalent in children following cataract extraction.

Expression Profiles of Inflammatory Cytokines in the Aqueous Humor of Children after Congenital Cataract Extraction.

PurposeTo investigate the change in cytokine microenvironment of the aqueous humor (AH) after surgery in children with congenital or developmental cataracts.MethodsAH samples were obtained from 59 eyes diagnosed with a congenital or developmental cataract. Thirty-three of these eyes were aphakic following previous cataract surgery and were scheduled for secondary intraocular lens (IOL) implantation. Additionally, AH samples from 26 eyes that had not undergone surgery were taken. AH samples were then analyzed for 16 different inflammatory immune mediators using multiplex bead immunoassays and enzyme-linked immunosorbent assay (ELISA).ResultsThe mean interval between secondary IOL implantation and original cataract surgery was 24.85 months (range, 9–60 months). Levels of IL-6, IP-10 (CXCL10), MCP-1 (CCL2), and IL-2 were significantly elevated in the AH of eyes after surgery compared to eyes that did not undergo surgery (P < 0.001, P = 0.047, P = 0.006, P = 0.012, respectively). There was significant correlation between the levels of TGF-β2 and intraocular pressure (IOP) in postsurgical and nonsurgical eyes (r = 0.532, P = 0.006; r = 0.57, P = 0.001). Postsurgical outcomes, such as iris adhesions, capsular fibrosis, and capsular contraction, were found not to be significantly associated with cytokine levels in the AH after surgery; however, IL-6 levels in capsular exposure eyes were significantly higher than those in cortical closure eyes (P = 0.023).ConclusionsTo our knowledge, this is the first study to report significantly increased proinflammatory cytokine levels in the AH after congenital cataract extraction in children. Our study also suggests that this proinflammatory state may be maintained for a prolonged period of time. Overall, these results give us insight into the relationship between the inflammatory cytokine microenvironment of the aqueous humor and potential long-term complications following congenital cataract surgery.Translational RelevanceThe inflammatory cytokine microenvironment of the aqueous humor might help explain potential long-term complications after surgery in patients with congenital or developmental cataracts.

Factors influencing target refraction in children with pseudophakia after extraction of congenital cataract

The article describes the factors affecting the target refraction of pseudophakic eyes of children after extraction of congenital cataracts. The factors include features of the echobiometric parameters of the eye, refraction, comorbidity of congenital cataracts and ocular pathologies, margins of error in calculating strength of the intraocular lens, localization and structure of the artificial lens, as well as correction of obscure or refractive amblyopia in pseudophakic eyes. Development of the algorithm for correction of residual refraction of pseudophakic eyes in children both before and after IOL implantation with consideration of each of those factors currently remains a relevant problem.