RESUMEN
BACKGROUND: Pediatric aphakia may be treated conservatively with aphakic contacts or spectacles. Many families and surgeons opt for a secondary intraocular lens (IOL) when the child is older. In certain situations, pediatric aphakic patients must undergo implantation earlier than planned. The purpose of this study was to investigate how often and why early implantation occurs. METHODS: We retrospectively reviewed the medical records of consecutive patients who were left aphakic after cataract surgery in infancy and were seen at our institute at ≥4 years of age. Early implantation was defined as occurring at <4 years of age. RESULTS: A total of 175 patients fit inclusion criteria. We found that 22 of 90 patients (24%) with unilateral cataracts had undergone early secondary IOL implantation before 4 years of age compared to 10 of 85 patients (12%) with bilateral cataracts, a statistically significant difference in the relative risk of early implantation (OR 2.43 [95% CI 1.07-5.49]). Of our patients undergoing early implantation, 15 of 31 (44%) had Medicaid as the primary insurance provider, which is representative of the practice overall. In patients requiring early implantation, failure with contact lens accounted for 26 of 32 cases (81%), with 7 of 26 (27%) of these failures attributed to nonmedical reasons. CONCLUSIONS: Of the factors we analyzed, only the presence of unilateral aphakia was associated with increased risk of early IOL implantation in our study cohort.
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Afaquia Poscatarata , Extracción de Catarata , Implantación de Lentes Intraoculares , Humanos , Estudios Retrospectivos , Masculino , Femenino , Preescolar , Afaquia Poscatarata/fisiopatología , Lactante , Niño , Lentes Intraoculares , Agudeza Visual/fisiología , Adolescente , Catarata/congénito , Factores de Riesgo , Factores de TiempoRESUMEN
PURPOSE: To evaluate Spot in detecting American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Amblyopia risk factors (ARF) and for ARF myopia and hyperopia with variations in ocular pigments. DESIGN: Diagnostic screening test evaluation. METHODS: Study population: Children presented for a complete eye examination in pediatric clinic. The study population included 1040 participants, of whom 273 had darkly pigmented eyes, 303 were medium pigmented, and 464 were light pigmented. INTERVENTION: Children were screened with the Spot vision screener before the complete eye examination. A pediatric ophthalmologist then completed an eye examination, including cycloplegic refraction. The pediatric ophthalmologist was blinded to the result of the Spot vision screener. MAIN OUTCOME: The association between Spot screening recommendation and meeting one or more ARF/ARF + Amblyopia criterion, Spot measured spherical equivalent, and ARF myopia and hyperopia detection. RESULTS: The area under the receiver operative characteristic curve (AUC) for myopia was excellent for all. The AUC for hyperopia was good (darker-pigmented: 0.92, medium-pigmented: 0.81, and lighter-pigmented: 0.86 eyes). The Spot was most sensitive for ARF myopia (lighter-pigmented: 0.78, medium-pigmented: 0.52, darker-pigmented: 0.49). The reverse was found for hyperopia; however, sensitivity was relatively poor. The Spot was found most sensitive for hyperopia in the darker-pigment group (0.46), 0.27 for medium-pigment, and 0.23 for the lighter-pigment cohort. CONCLUSIONS: While the Spot was confirmed as a sensitive screening test with good specificity in our large cohort, the sensitivity of the Spot in detecting AAPOS guidelines for myopia and hyperopia differed with variations in skin pigment. Our results support the consideration of ethnic and racial diversity in future advances in photorefractor technology.
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Ambliopía , Hiperopía , Miopía , Curva ROC , Selección Visual , Humanos , Masculino , Femenino , Hiperopía/diagnóstico , Hiperopía/fisiopatología , Miopía/diagnóstico , Miopía/fisiopatología , Niño , Selección Visual/métodos , Selección Visual/instrumentación , Preescolar , Ambliopía/diagnóstico , Ambliopía/fisiopatología , Color del Ojo , Factores de Riesgo , Sensibilidad y Especificidad , Refracción Ocular/fisiología , Área Bajo la Curva , Pigmentos Retinianos/metabolismo , Reproducibilidad de los Resultados , AdolescenteRESUMEN
PURPOSE: To perform the external validation of a model to predict postoperative axial length (AL) in children over 2 years of age who were undergoing bilateral cataract surgery with primary intraocular lens (IOL) implantation. DESIGN: Validation study using a retrospective case series. METHODS: Using a population different from the one that created the model, but with the same characteristics regarding age, bilateral cataract, primary IOL implantation, and follow-up assessment, AL was estimated. The AL values estimated by the model were compared with the AL measured in the follow-ups. RESULTS: In all, 55 eyes of 30 children were selected for this study; in 5 children with bilateral cataracts, only 1 eye was included. The median age at the time of surgery was 5.01 years. Follow-up AL measurements were obtained for 179 visits. The median age at the final follow-up visit was 10.15 years. The median AL measured and estimated by the model in all visits were 22.37 mm and 22.16 mm, respectively (Pearson coefficient: 0.9534; Lin correlation: 0.9258). In the Bland-Altman analysis, the 95% limit of agreement between the 2 methods (measured and estimated AL) was 0.71 to -1.19. In 3 eyes (1.68%) with AL shorter than 21.2 mm, the difference was >0.71, and in 9 eyes with AL longer than 22.5 (5.03%), it was less than -1.19. The median AL measured and estimated at the final visit were 22.69 mm and 22.43 mm, respectively. CONCLUSION: Our previously developed prediction model for globe AL growth demonstrated good external validity by accurately predicting measured AL changes with growth in the validation cohort.
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Longitud Axial del Ojo , Extracción de Catarata , Implantación de Lentes Intraoculares , Humanos , Longitud Axial del Ojo/patología , Longitud Axial del Ojo/diagnóstico por imagen , Estudios Retrospectivos , Femenino , Masculino , Niño , Preescolar , Periodo Posoperatorio , Biometría , Estudios de Seguimiento , Catarata/fisiopatología , Agudeza Visual/fisiología , AdolescenteRESUMEN
PURPOSE: To report the findings of our systematic review and meta-analysis comparing the completion time and testing time of visual acuity testing using Lea Symbols or HOTV optotypes. METHODS: A systematic search of PubMed, SCOPUS, and CINAHL was conducted according to the PRISMA guidelines. RESULTS: The completion rate for HOTV optotypes and Lea Symbols visual acuity testing was reported for 7,948 patients (average age, 3.59 years; age range, 2-17; 49.96% females). The 3-year-olds' completion rate of HOTV was 74.09% (47.93%-93.29%), compared with a Lea Symbols completion rate of 77.80% (53.93%-94.57%). The 4-year-olds' completion rate was 88.20% (63.48%-99.73%) for HOTV and 90.118% (67.42%-99.90%) for Lea Symbols. In 3-year-olds, the mean testing time was 118.33 ± 6.54 seconds for HOTV and 120.33 ± 6.53 seconds for Lea Symbols (P < 0.0001). The difference in testing times in the 4-year-old age group was also statistically significant (86.98 ± 6.12 seconds for HOTV and 94.32 ± 6.57 seconds for Lea symbols) (P < 0.0001). CONCLUSIONS: There was a statistically significant difference in the testing times between the HOTV optotypes and Lea Symbols in both the 3- and 4-year-old age groups; however, the difference of 2-7 seconds on average is unlikely to be clinically significant. Testing speed and completion rate improve with age for both tests.
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Agudeza Visual , Humanos , Agudeza Visual/fisiología , Pruebas de Visión/métodos , Niño , Preescolar , Adolescente , Factores de TiempoRESUMEN
We present the case of a 14-year-old boy with a known diagnosis of Knobloch syndrome (KS) referred for bilateral cataract evaluation and possible cataract surgery. At time of initial presentation, no lens subluxation was appreciated, and no phacodonesis was detected on slit lamp biomicroscopy. However, 7-weeks later, on the day of surgery, his right eye was found to have a complete lens dislocation into the vitreous cavity, with no zonule attachment. The left eye did not have subluxated lens; however, intraoperatively, after irrigation into the eye, near complete zonular dialysis was observed. This case highlights the importance of regular follow-up of children with KS.
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Extracción de Catarata , Catarata , Subluxación del Cristalino , Cristalino , Masculino , Humanos , Niño , Adolescente , Subluxación del Cristalino/diagnóstico , Subluxación del Cristalino/etiología , Subluxación del Cristalino/cirugía , Cristalino/cirugía , Catarata/complicaciones , Catarata/diagnósticoRESUMEN
Cerebrotendinous xanthomatosis (CTX) is a rare, autosomal recessive bile acid synthesis disorder caused by pathologic variants in CYP27A1, a gene involved in bile acid synthesis. Impaired function in this gene leads to accumulation of plasma cholestanol (PC) in various tissues, often in early childhood, resulting in such clinical signs as infantile diarrhea, early-onset bilateral cataracts, and neurological deterioration. The current study aimed to identify cases of CTX in a population of patients with a greater CTX prevalence than the general population, to facilitate early diagnosis. Patients diagnosed with early-onset, apparently idiopathic, bilateral cataracts between the ages of 2 and 21 years were enrolled. Genetic testing of patients with elevated PC and urinary bile alcohol (UBA) levels was used to confirm CTX diagnosis and determine CTX prevalence. Of 426 patients who completed the study, 26 met genetic testing criteria (PC ≥ 0.4 mg/dL and positive UBA test), and 4 were confirmed to have CTX. Prevalence was found to be 0.9% in enrolled patients, and 15.4% in patients who met the criteria for genetic testing.
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Catarata , Xantomatosis Cerebrotendinosa , Preescolar , Humanos , Niño , Adolescente , Adulto Joven , Adulto , Xantomatosis Cerebrotendinosa/diagnóstico , Xantomatosis Cerebrotendinosa/epidemiología , Xantomatosis Cerebrotendinosa/genética , Prevalencia , Colestanol , Ácidos y Sales Biliares , Catarata/diagnóstico , Catarata/epidemiología , Catarata/genéticaRESUMEN
PURPOSE: To compare the preoperative central corneal thickness (CCT) in eyes with unilateral cataract with their normal fellow eyes in the pediatric population. METHODS: A retrospective chart review was conducted using the STORM Kids cataract database. Eyes with traumatic cataract, previous surgery or therapeutic manipulation, or age >18 years were excluded. Only eyes with a normal fellow eye were included. The intraocular pressure, age at time of surgery, race, sex, and type of cataract were also extracted from the record. RESULTS: A total of 70 eyes with unilateral cataract and 70 fellow normal eyes met inclusion criteria. The mean age at the time of surgery was 3.35 years (range, 0.08-15.05). The mean preoperative CCT in the operated eyes was 577 ± 58 µm (range, 464-898 µm). The mean preoperative CCT in fellow eyes was 570 ± 35 µm (range, 485-643 µm). There was no statistically significant difference between the preoperative CCT in cataract eyes versus unaffected fellow eyes (P = 0.183). When stratified by age, the difference in the CCT between cataract and fellow eyes was greatest in the <1 year age group, but was not statistically significant (P = 0.236). The mean preoperative corneal diameter of operative eyes was 11.0 mm (range, 5.5-12.5 mm [n = 68]). The mean preoperative IOP was 15.1 mm Hg (n = 66). CONCLUSIONS: In our study cohort, there was no significant difference in mean preoperative CCT between unilateral pediatric cataract eyes and unaffected fellow eyes.
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Extracción de Catarata , Catarata , Niño , Humanos , Recién Nacido , Lactante , Preescolar , Adolescente , Estudios Retrospectivos , Córnea/cirugía , Tonometría Ocular , Presión IntraocularRESUMEN
PURPOSE: To quantify typical disease characteristics for patients with congenital fibrosis of the extraocular muscles (CFEOM) including pre-and post-surgical ocular alignment and head positioning as well as average improvement with surgical intervention. PATIENTS AND METHODS: This investigation is a systematic review and meta-analysis. All studies detailing surgical intervention in cohorts of individuals with CFEOM were included. Ocular alignment and head positioning before and after surgery was recorded. Meta-analyses were performed to quantify these findings along with other patient characteristics across all included studies. RESULTS: The estimated average improvement in vertical alignment for patients with unilateral and bilateral CFEOM was 34.8 pd (prism diopters) and 21.27 pd, respectively. For horizontal alignment, patients with unilateral and bilateral CFEOM improved an average of 25.39 pd and 10.99 pd after surgery, respectively. There was no significant difference between the two most common surgeries used to address hypotropia and blepharoptosis in this patient population. The estimated proportion of patients with post-surgical head alignment within 5-9° was 60.64% and was 28.25% for patients with<5° of alignment. CONCLUSION: This study was able to illuminate many characteristic features of patients with CFEOM. Surgical intervention for the ocular alignment and head positioning of these patients demonstrates promising utility.
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Oftalmoplejía , Estrabismo , Humanos , Músculos Oculomotores/cirugía , Músculos Oculomotores/patología , Oftalmoplejía/cirugía , Estrabismo/congénito , FibrosisRESUMEN
PURPOSE: To evaluate the Spot Vision Screener according to updated 2021 AAPOS Vision Screening Committee guidelines for instrument-based pediatric vision screen validation. METHODS: As part of an IRB-approved ongoing prospective study, children were screened with the Spot prior to a complete examination. RESULTS: Spot screening was successful in 1,036 of 1,090 children (95%). Forty-eight percent of participants were referred for further screening using the Spot manufacturer guidelines, and 40% of all children were found to have a 2021 amblyopia risk factor or visually significant refractive error by gold standard examination. The Spot recommendation compared reasonably well to the 2021 criteria, with an overall sensitivity of 0.88 and a specificity of 0.78. Applying updated guidelines to the Spot for hyperopia, anisometropia, and astigmatism yielded moderate-to-poor sensitivity (0.27-0.77) but excellent specificity (>0.9). The area under the curve of the receiver operating characteristic analysis demonstrates overall good prediction performance for the Spot for each diagnosis-myopia, hyperopia, astigmatism, anisometropia (range, 0.87-0.97). Results of our study suggest increasing the instrument referral criterion for astigmatism from 1.5 D (manufacturer thresholds of the screener used in this study) to 2 D in older children. Decreasing the anisometropia cut-off from 1 D to 0.75 D would improve sensitivity from 0.59 to >0.8. CONCLUSIONS: In our study population, the overall predictive ability of the Spot is good, with a sensitivity of 0.88 and a specificity of 0.78. We recommend specific device refractive referral criteria to maximize screening effectiveness using the updated AAPOS guidelines.
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Ambliopía , Anisometropía , Astigmatismo , Hiperopía , Errores de Refracción , Selección Visual , Niño , Humanos , Astigmatismo/diagnóstico , Anisometropía/diagnóstico , Hiperopía/diagnóstico , Sensibilidad y Especificidad , Estudios Prospectivos , Ambliopía/diagnósticoRESUMEN
PURPOSE: The blinq (Rebion Inc) is a new screening device designed to directly detect amblyopia and strabismus rather than amblyopia risk factors. We performed an independent assessment of the effectiveness of the blinq in detecting amblyopia and strabismus. DESIGN: Prospective clinical validity analysis of a screening device based on sensitivity and specificity. METHODS: Children presenting for examination in the pediatric ophthalmology clinic underwent screening with the blinq before examination by a pediatric ophthalmologist blinded to the screening results. Results of the blinq and examination findings of strabismus or amblyopia were compared. RESULTS: In our cohort of 267 children with an average age of 6.3 years, the sensitivity of the blinq to detect amblyopia or any constant strabismus was 87.5% (78.2%-93.8%) and specificity was 51.3% (43.9%-58.7%). Using the previously described "appropriate referral gold standard" criteria, including children with intermittent strabismus and high refractive error, the sensitivity increased to 91.3% and the specificity to 63.2%. We found a high number of children (44 [16%]) upon whom the blinq timed out and were included as automatic referrals. CONCLUSIONS: Our results support use of the blinq as a screening device to detect amblyopia and strabismus in children.
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Ambliopía , Errores de Refracción , Estrabismo , Selección Visual , Niño , Humanos , Ambliopía/diagnóstico , Estudios Prospectivos , Estrabismo/diagnóstico , Errores de Refracción/diagnóstico , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To compare outcomes of unilateral cataract surgery in children aged 2-7 years with the outcomes reported in younger children. METHODS: The medical records of patients who underwent unilateral cataract surgery between the ages of 2-7 years were reviewed retrospectively. Traumatic cataracts and ectopia lentis were excluded. Outcomes were compared to those of the Infant Aphakia Treatment Study (IATS) for infants up to 7 months of age and the Toddler Aphakia and Pseudophakia Study (TAPS) for toddlers between 7-24 months of age who underwent unilateral cataract surgery. RESULTS: A total of 68 children were included, with a mean follow-up of 4.3 years. The proportion of intraoperative complications (7%) was significantly lower than that reported in IATS but not significantly different from that of TAPS. In our older cohort, more children (41%) had visual acuity better than 20/40 compared to infants (23% [P < 0.05]) and toddlers (11% [P < 0.001]), with a final median visual acuity of 20/44. The proportion of adverse events in our older cohort was reduced (7%) compared to that of infants (81%) and toddlers (24%). Additional unplanned intraocular surgeries occurred less often (6%) than in the infant cohort (72%). No patients developed glaucoma. CONCLUSIONS: Cataract surgery in slightly older children carries less risk of vision-threatening complications and adverse events compared to infants and results in better visual outcomes than in toddlers. Once the decision is made to pursue surgery on a visually significant cataract, the age of the child should determine which relevant risks are emphasized in the informed consent discussion.
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Afaquia Poscatarata , Extracción de Catarata , Catarata , Adolescente , Afaquia Poscatarata/cirugía , Catarata/etiología , Extracción de Catarata/métodos , Niño , Preescolar , Estudios de Seguimiento , Humanos , Lactante , Implantación de Lentes Intraoculares/métodos , Seudofaquia , Estudios RetrospectivosRESUMEN
PURPOSE: To report long-term outcomes of iris claw aphakia intraocular lens (IOL) implantation for nontraumatic ectopia lentis (EL) in children. METHODS: In this prospective study, children who underwent Artisan Aphakia IOL placement were included if they have a minimum of 1-year follow-up after implantation. Main outcome measures were: best-corrected distance visual acuity, reoperations, change in central corneal thickness (CCT), and corneal endothelial cell counts (ECC). RESULTS: The Artisan Aphakia IOL was implanted in a total of 76 eyes of 43 patients (68 eyes of 34 patients with EL). 56 eyes of 28 patients have been followed long enough to meet the inclusion criteria for this report. The average age at Artisan Aphakia IOL implantation was 11.1 years (range of 2-20 years). Average follow-up was 3.59 years, and 23% of patients have >5 years' follow-up. Mean best-corrected visual acuity improved from 0.36 (20/46) to logMAR 0.18 (20/30) after implantation (P = 0.02). Five reoperations were needed in 4 patients, 3 (7%) related to post-implantation trauma. Average preoperative CCT was 580 µm; estimated mean increase in CCT at the 5-year postoperative visit was 11.9 µm higher (P = 0.047). Average preoperative ECC was 3178 cells/mm2; estimated mean loss of ECC at the 5-year postoperative visit was not significantly different from zero (187.7 cells/mm2 [P = 0.102]). CONCLUSIONS: The Artisan Aphakia IOL, used in the absence of capsular support, had an acceptable safety profile in our patients.
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Afaquia Poscatarata , Afaquia , Desplazamiento del Cristalino , Lentes Intraoculares , Adolescente , Adulto , Afaquia/cirugía , Afaquia Poscatarata/cirugía , Niño , Preescolar , Desplazamiento del Cristalino/complicaciones , Desplazamiento del Cristalino/cirugía , Estudios de Seguimiento , Humanos , Implantación de Lentes Intraoculares , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Agudeza Visual , Adulto JovenRESUMEN
PURPOSE: To evaluate the outcomes of bilateral cataract surgery in children 2-7 years of age in our institution and to compare them to the bilateral infant and toddler outcomes of the Toddler Aphakia Pseudophakia Study (TAPS) registry. METHODS: The medical records of children who underwent bilateral cataract surgery between the ages of 2 and 7 years of age with a minimum of 2 years' postoperative follow-up were reviewed retrospectively. Patients with a history of trauma or subluxated lenses were excluded. Main outcome measures were best-corrected visual acuity, strabismus requiring surgery, adverse events, and reoperations. RESULTS: A total of 114 eyes of 57 children were included. Median age at surgery was 4.4 years. At the visit closest to 10 years of age, the median best-corrected visual acuity of the better-seeing eye was 0.05 logMAR (20/22); of the worse-seeing eye, 0.18 logMAR (20/30). Strabismus surgery was performed in 1 patient. Among first-operated eyes, adverse events occurred in 4 eyes (7%), which was significantly less than in the TAPS cohort of 1-7 months (P = 0.0001) and the TAPS cohort of 7 months to 2 years (P = 0.01). No eye developed glaucoma or was labeled glaucoma suspect. Unplanned intraocular reoperations were needed in 4 first-operated eyes (3 membranectomy/vitrectomy for removal of opacifications and 1 lysis of vitreous wick). CONCLUSIONS: Compared to infants and toddlers, bilateral cataract surgery performed between 2 and 7 years of age was associated with significantly fewer adverse events and excellent visual acuity.
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Afaquia , Extracción de Catarata , Catarata , Glaucoma , Estrabismo , Afaquia/etiología , Catarata/etiología , Extracción de Catarata/métodos , Niño , Preescolar , Estudios de Seguimiento , Glaucoma/etiología , Humanos , Lactante , Implantación de Lentes Intraoculares/métodos , Complicaciones Posoperatorias/etiología , Seudofaquia , Estudios Retrospectivos , Estrabismo/etiología , Estrabismo/cirugíaAsunto(s)
Afaquia Poscatarata , Afaquia , Extracción de Catarata , Miopía , Afaquia Poscatarata/terapia , Estudios de Seguimiento , Humanos , Lactante , Miopía/terapiaRESUMEN
Purpose: For those children that went on to have strabismus surgery after cataract surgery, we sought to identify preoperative predictors for whether strabismus surgery would be for an esodeviation or for an exodeviation.Design: Retrospective studyMethods: Charts of patients <18 years who underwent cataract surgery were reviewed. Data from the first strabismus surgery after cataract surgery were reviewed. Statistical analysis was performed using T-test for continuous variable and chi-square test for categorical variable. A binomial logistic regression was performed to ascertain the effects of variables that were found to be significant.Results: 142 patients were identified having strabismus surgery. Type of deviation at first strabismus surgery was: Esodeviation: 72 (50.7%), exodeviation 55 (38.7%), and surgery for only vertical strabismus 15 (10.6%). Age at cataract surgery was an independent variable determining subsequent surgery for esodeviation or exodeviation. For each year increase in age at cataract surgery, the odds of having surgery for exotropia instead of esotropia increases by a factor of 1.620 (P = .005). Odds that strabismus surgery will be for exodeviation is 4.9 times higher in children who had cataract surgery at 1 year of age or greater as compared to children <1 year of age (P < .001).Conclusion: For those children who went on to have strabismus surgery after cataract surgery, younger age at cataract surgery increases the chance that subsequent strabismus surgery will be for an esodeviation. Those who had cataract surgery at an older age were more likely to have surgery for exotropia than for esotropia.
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Catarata , Esotropía , Exotropía , Anciano , Niño , Exotropía/cirugía , Humanos , Estudios Retrospectivos , Visión Binocular , Agudeza VisualRESUMEN
OBJECTIVES: To report the myopic shift in the aphakic eyes of a cohort of children who underwent unilateral cataract surgery during infancy and were then followed longitudinally for 10.5 years. METHODS: One-half of the children enrolled in the Infant Aphakia Treatment Study (IATS) were randomized to aphakia and contact lens correction after unilateral cataract surgery. They then underwent ocular examinations using standardized protocols at prescribed time intervals until age 10.5 years. RESULTS: Thirty of 57 children randomized to aphakia remained aphakic at age 10.5, having undergone unilateral cataract surgery at a median age of 1.6 (IQR: 1.1-3.1) months. The median refractive error (RE) in the 57 eyes randomized to aphakia immediately after cataract surgery was 19.01 D (IQR: 16.98-20.49) compared to 10.38 D (IQR: 7.50-14.00) for the 30 eyes that remained aphakic at age 10.5 years. The mean change in RE in aphakic eyes was -2.11 D/year up to age 1.5 years, -0.68 D/year from 1.5 to 5.0 years, and -0.35 D/year from age 5 to 10.5 years. At age 10.5 years, 18 patients continued to wear a contact lens correction (silicone elastomer, n=6; gas permeable, n=6; hydrogel, n=5; and silicone hydrogel, n=1) (median RE, 12.50 D), 9 wore only spectacles (median RE, 4.00 D), and 4 wore no correction (median RE, 11.25 D) to correct their aphakic eye. CONCLUSIONS: The RE in aphakic eyes decreased by 44% from infancy to age 10.5 years. About two-thirds of children who remained aphakic at age 10.5 years continued to wear a contact lens.
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Afaquia Poscatarata , Extracción de Catarata , Catarata , Afaquia Poscatarata/etiología , Afaquia Poscatarata/terapia , Niño , Preescolar , Estudios de Seguimiento , Humanos , Lactante , Implantación de Lentes Intraoculares , Agudeza VisualRESUMEN
PURPOSE: To compare intraocular pressure (IOP) control before and during the first year after secondary intraocular lens (IOL) implantation in children. METHODS: This was a retrospective chart review of children who received secondary IOL implantation. We analyzed IOP and antiglaucoma medications before and after implantation. The latest exam with IOP measurement found within the 2-15 month period after IOL implantation was used for the postoperative data. Failure to maintain IOP control was defined as either the addition of antiglaucoma medication(s) or a rise in IOP > 4 mm Hg. Statistical analyses were performed to assess risk factors for failure to control IOP after surgery, namely age at IOL implantation, preoperative glaucoma status, and IOL fixation location. RESULTS: A total of 100 eyes were included. The mean duration of follow-up was 7.74 months (SD = 3.11). Twenty-three of one hundred eyes failed to maintain IOP control according to our definition. Eyes with a history of having had a traumatic cataract (n = 3) had a more than threefold increased risk of failure (P = 0.015). Although not statistically significant, very young age at initial cataract surgery (<2 months old) had a twofold increased risk of failure compared to an older age (>12 months old) (P = 0.213). No other risk factors were found to have statistical significance. CONCLUSION: Secondary IOL implantation carries a modest risk of worsening IOP control in the first year after implantation, for which, a history of ocular trauma or young age at initial cataract surgery seems to present the highest risk.
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Catarata , Lentes Intraoculares , Facoemulsificación , Anciano , Niño , Humanos , Lactante , Presión Intraocular , Implantación de Lentes Intraoculares , Estudios Retrospectivos , Tonometría OcularRESUMEN
PURPOSE: To evaluate outcomes of bilateral cataract surgery in children aged 7 to 24 months and compare rates of adverse events (AEs) with other Toddler Aphakia and Pseudophakia Study (TAPS) registry outcomes. DESIGN: Retrospective clinical study at 10 Infant Aphakia Treatment Study (IATS) sites. Statistical analyses comparing this cohort with previously reported TAPS registry cohorts. PARTICIPANTS: Children enrolled in the TAPS registry between 2004 and 2010. METHODS: Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement at age 7 to 24 months with 5 years of postsurgical follow-up. MAIN OUTCOME MEASURES: Visual acuity (VA), occurrence of strabismus, AEs, and reoperations. RESULTS: A total of 40 children (76 eyes) who underwent bilateral cataract surgery with primary posterior capsulectomy were identified with a median age at cataract surgery of 11 months (7-23); 68% received a primary IOL. Recurrent visual axis opacification (VAO) occurred in 7.5% and was associated only with the use of an IOL (odds ratio, 6.10; P = 0.005). Glaucoma suspect (GS) was diagnosed in 2.5%, but no child developed glaucoma. In this bilateral cohort, AEs (8/40, 20%), including glaucoma or GS and VAO, and reoperations occurred in a similar proportion to that of the published unilateral TAPS cohort. When analyzed with children aged 1 to 7 months at bilateral surgery, the incidence of AEs and glaucoma or GS correlated strongly with age at surgery (P = 0.011/0.004) and glaucoma correlated with microcornea (P = 0.040) but not with IOL insertion (P = 0.15). CONCLUSIONS: Follow-up to age 5 years after bilateral cataract surgery in children aged 7 to 24 months reveals a low rate of VAO and very rare glaucoma or GS diagnosis compared with infants with cataracts operated at < 7 months of age despite primary IOL implantation in most children in the group aged 7 to 24 months. The use of an IOL increases the risk of VAO irrespective of age at surgery.
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Afaquia Poscatarata/epidemiología , Extracción de Catarata , Implantación de Lentes Intraoculares , Seudofaquia/epidemiología , Catarata/congénito , Preescolar , Femenino , Estudios de Seguimiento , Glaucoma/diagnóstico , Glaucoma/etiología , Humanos , Lactante , Lentes Intraoculares/efectos adversos , Masculino , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Agudeza Visual/fisiologíaRESUMEN
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 1-2 weeks 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.