Long-term results after primary intraocular lens implantation in children with juvenile idiopathic arthritis-associated uveitis.

PURPOSE: To evaluate the long-term outcome after cataract surgery with primary intraocular lens implantation in children with juvenile idiopathic arthritis-associated uveitis. METHODS: The medical records of all 24 children (34 eyes) with chronic juvenile idiopathic arthritis-associated uveitis who underwent cataract surgery between 1990 and 2013 were reviewed retrospectively. Primary intraocular lens implantation was performed in all patients. RESULTS: Median age at diagnosis of uveitis in the first eye was 5.3 years (range: 2.7-9.4 years) and median age at the time of cataract surgery in the first eye was 9.7 years (range: 4.1-16.9 years). Postoperative follow-up time ranged from 1 to 23.1 years, with a median of 10.9 years. Best corrected visual acuity at the last follow-up was good (⩾20/40) in 65% of the eyes. Postoperatively, glaucoma developed in 8 eyes (24%), posterior capsular opacification and secondary membrane formation requiring surgery in 15 eyes (44%), macular oedema in 5 eyes (15%) and phthisis in 2 eyes (6%). CONCLUSION: This study shows a favourable visual outcome in most of the cases. Primary intraocular lens implantation may be considered in juvenile idiopathic arthritis-associated uveitis complicated by cataract in patients with well-controlled inflammation.

The Paediatric Cataract Register (PECARE): an overview of operated childhood cataract in Sweden and Denmark.

AIM: To report basic epidemiological data concerning surgically treated childhood cataract in Sweden and Denmark. METHODS: Data were derived from the Paediatric Cataract Register (PECARE), a binational, web-based surgical register representing Sweden and Denmark. All children operated before 8 years of age between 1 January 2007 and 31 December 2013 were included. Age-specific prevalence per 100 000 population was calculated. RESULTS: A total 574 operations in 213 boys (51.7%) and 199 girls (48.3%), altogether 412 children, were registered, the vast majority (n = 395/412; 95.9%) being individuals with congenital/infantile cataract. Of these 412, a total of 294 (147 boys and 147 girls) were Swedish and 118 (66 boys and 52 girls) were Danish. The age-specific prevalence of operated cataract in Sweden was 31/100 000 and in Denmark 28/100 000. In 454 of 574 eyes (79.1%), the cataract was dense. Altogether, 266 of 574 (46.3%) were operated during the first year of life, 193 during the first 12 weeks representing 33.6% of all operations. A primary intraocular lens (IOL) implantation was done in altogether 411 of 574 eyes (71,6%). In total, 210 unilateral cataract operations (210/574; 36.6%) were performed. Persistent fetal vasculature (PFV) was present in 64 of 193 (33.1%) of those with a congenital unilateral cataract. In 84 individuals (84/395; 21.3%) with congenital or infantile cataract, a coexisting disorder was found. CONCLUSION: The age-specific binational prevalence of operated congenital/infantile cataract in Sweden and Denmark is 30/100 000. About half of the operations are performed within the first year of life, one-third within the first 3 months. In our study population, a primary IOL was implanted in the majority of cases.

Application of the ICare rebound tonometer in healthy infants.

PURPOSE: To study the tolerability of the ICare rebound tonometer (RBT) and to establish reference values of the intraocular pressure (IOP) in healthy infants. PARTICIPANTS AND METHODS: Forty-six children were recruited. In 6 infants aged 3 to 18 months, it was not possible to conduct the examination. Five children refused all cooperation. In 1 child, only 1 reading was obtained. In 1, partly uncooperative infant, the difference between the highest and the lowest reading exceeded 3 mm Hg (a difference of 7 mm Hg). These 7 infants were excluded. Totally 39 children, 22 girls and 17 boys, aged 1 month to 36 months were included in the study. The mean age was 14±9 months [mean ± standard deviation (SD)]. One randomly selected eye of each child was examined with the ICare RBT. Three consecutive readings were made. In 10 children, IOP measurements were conducted twice with an interval of 10 to 30 minutes by 2 different ophthalmologists. RESULTS: The mean IOP value of the 39 infants was 11.82±2.67 mm Hg. The median value was 10 mm Hg with a range of 7.3 to 17.0 mm Hg. In 10 children, the IOP was determined by 2 examiners. The results were virtually identical with differences of 0 to 1 mm Hg in 9 out of 10 children. The mean difference between Examiner 1 and Examiner 2 (0.77 mm Hg) was not statistically significant (P>0.20). The examinations were very well tolerated, and no child showed any sign of discomfort during or after the examination. CONCLUSIONS: The hand-held RBT in the present study is easy to use, it does not require topical anesthesia and it is very well tolerated by cooperative infants. However, 7 out of 46 infants refused cooperation.

Thickness of the retinal nerve fibre layer estimated with the scanning laser polarimeter in healthy children.

PURPOSE: The scanning laser polarimeter [GDx variable corneal compensation (VCC)] measures the thickness of the retinal nerve fibre layer (RNFL) and has, therefore, a possible potential for the diagnosis and follow-up of glaucoma in children. The aim of the present study is to establish reference values of the RNFL thickness in children. METHODS: The RNFL thickness was measured with a GDx VCC in 72 children aged 4 to 15 years without ocular diseases. The difference in the temporal-superior-nasal-inferior-temporal (TSNIT) average (TA), superior average (SA), and inferior average (IA) between the boys and the girls was estimated with a t test. A 95% confidence interval (CI) of the TA, SA, and IA was calculated for the whole group and compared with those of 4 previous studies. The reproducibility of the examination was estimated in 10 consecutive children and was expressed as 95% CI of the differences between the repeated measurements. RESULTS: There were no statistically significant differences in the TA, SA, and IA between the boys and girls. The 95% CI for the TA, SA, and IA was 61.1+/-1.5, 73.5+/-2.3, and 73.5+/-2.0 microm, respectively. These values did not overlap with those reported previously in the adult groups, confirming a statistically significant age-related thinning of the RNFL. The 95% CI of the differences between the repeated measurements was -0.4+/-1.4 microm for TA, -1.5+/-3.6 microm for SA, and 1.6+/-3.9 microm for IA, suggesting that the examination was reproducible. CONCLUSIONS: The GDx VCC examination is reproducible in children. The present RNFL results should represent useful reference values in the evaluation of pediatric glaucoma.

Primary intraocular lens implantation in infants: complications and visual results.

PURPOSE: To evaluate the complications and visual results in a consecutive series of patients having cataract extraction with intraocular lens (IOL) implantation in the first year of life. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: This retrospective study comprised 28 children (31 eyes) who had cataract surgery with primary IOL implantation. RESULTS: The median age at surgery was 2.5 months (range 8 days to 10 months). The median follow-up was 36 months. Two newborns with persistent fetal vasculature (PFV) who had surgery at 8 days and 17 days, respectively, developed intraoperative vitreous hemorrhage; a retinal detachment developed in 1 of the eyes. Intraocular lens luxation occurred in 2 infants with PFV. Seventy percent of eyes developed opacification of the visual axis that required additional surgery. Chronic glaucoma developed in 2 eyes and transitory glaucoma in 1 eye. Two of the glaucoma cases occurred in eyes with PFV. In 7 eyes of 4 infants with bilateral cataract, the median visual acuity was 20/63 (range 20/25 to 20/100). In 12 infants with unilateral cataract without PFV, 7 achieved a visual acuity between 20/32 and 20/200 (median 20/63), 4 achieved counting fingers (CF), and 1 achieved light perception. In 12 eyes with PFV, 2 achieved a visual acuity of 20/200 and the rest achieved CF or worse. CONCLUSIONS: After-cataract with membrane formation was the main complication in infants with primary IOL implantation. The glaucoma incidence was low at the last follow-up.

Cataracts in children.

Bilateral congenital cataract is the most common cause of treatable childhood blindness. Nuclear cataract is usually present at birth and is nonprogressive, whereas lamellar cataract usually develops later and is progressive. Surgery must be performed promptly in cases with dense congenital cataract; if nystagmus has developed, the amblyopia is irreversible. A treatment regimen based on surgery within 2 months of birth combined with prompt optical correction of the aphakia and aggressive occlusion therapy with frequent follow-up has been successful in unilateral and bilateral cases. Both anterior and posterior capsulorhexes are performed in most children. Intraocular lens implantation can be performed safely in children older than 1 year. Anterior dry vitrectomy is recommended in preschool children to avoid after-cataract. Opacification of the visual axis is the most common complication of cataract surgery in children. Secondary glaucoma is the most sight-threatening complication and is common if surgery is performed early. Life-long follow-up is essential in these cases.

Effect of 3-piece AcrySof and downsized heparin-surface-modified poly(methyl methacrylate) intraocular lenses in infant rabbit eyes.

PURPOSE: To evaluate after-cataract formation, ocular growth, and intraocular lens (IOL) behavior in lensectomized infant rabbit eyes implanted with a downsized heparin-surface-modified poly(methyl methacrylate) (HSM PMMA) IOL with long haptics or a 3-piece AcrySof(R) IOL (Alcon Laboratories, Inc.). SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: Clear lens extraction was performed in both eyes of 3-week-old rabbits. In Group 1 (n = 9), a downsized HSM PMMA IOL with long haptics was implanted in 1 eye and in Group 2 (n = 9), a 3-piece AcrySof IOL was implanted in 1 eye. The fellow eyes remained aphakic. RESULTS: The amount of after-cataract was significantly less in the eyes with the IOLs than in the aphakic eyes. The eyes with the HSM PMMA IOL had significantly less after-cataract than those with the AcrySof IOL. No significant difference in axial length was noted between the IOL eyes and the aphakic eyes in either group. In the eyes with the 3-piece AcrySof IOL, there was anterior movement of the optic with occlusion of the pupil. CONCLUSIONS: Eyes with the HSM PMMA IOL and the AcrySof IOL had less after-cataract than the aphakic eyes. The HSM PMMA IOL, however, inhibited after-cataract production significantly better than the AcrySof IOL. The 3-piece AcrySof IOL was seriously deformed in the infant rabbit eyes and caused occlusion of the pupil. Surgeons should be cautious in implanting this AcrySof IOL in the eyes of newborns or in eyes with severe microphthalmia.

Outcome after treatment of congenital unilateral cataract.

PURPOSE: To evaluate long-term functional outcome after treatment of congenital unilateral cataract. METHODS: The records of 30 consecutive children operated on before the age of 12 months at St. Erik's Eye Hospital over a 5-year period (1991-96) were reviewed retrospectively. The patients were followed until 4-9.5 years of age. Linear Snellen visual acuity (VA), occlusion therapy compliance, and the presence of nystagmus, strabismus and other complications are reported. RESULTS: Six children achieved VA of 0.1 or better. They were all operated on before 3 months of age. Of the 12 infants operated on before 6 weeks of age, four have VA between 0.3 and 0.4 and eight have VA of finger counting or less. Four developed severe secondary glaucoma within 6 months of cataract extraction. Two of these had persistent fetal vasculature. Three eyes developing glaucoma became amaurotic. Occlusion therapy was abandoned before the age of 2.5 years in 21 children. CONCLUSION: Good levels of VA were achieved only in children who underwent cataract surgery before 3 months of age and who adhered to the occlusion therapy schedule. Severe secondary glaucoma developed in four out of 12 children operated on within 6 weeks. Full compliance with the occlusion therapy programme was uncommon.

Outcome after treatment of congenital bilateral cataract.

PURPOSE: To evaluate long-term functional outcome after treatment of dense congenital bilateral cataract. METHODS: The records of 22 consecutive children operated on before the age of 12 months at St. Erik's Eye Hospital over a 5-year period (1991-96) were reviewed retrospectively. Linear Snellen visual acuity (VA) at last check, presence of stereoacuity, nystagmus, strabismus and other complications are accounted for. Subject age at last check ranged from 4 to 9 years. RESULTS: Visual acuity could be estimated in 19 children: the median VA of the better eye was 0.4 (range: counting fingers - 0.8) and of the fellow eye 0.15 (range: amaurosis - 0.8). In nine otherwise healthy children who were operated on early (by 1 month of age), VA varied from 0.4 to 0.8 in the better eye. Four of these children achieved stereopsis. Pupillary block glaucoma developed in five eyes (in three children). Chronic glaucoma developed in eight eyes (in five children). Glaucoma occurred predominantly in children who underwent cataract extraction during the first week of life. Two of the latter had marked microphthalmos. CONCLUSION: Good postoperative VA was achieved in most healthy children with dense bilateral congenital cataract when surgery was performed early (before 6-8 weeks of age). Chronic glaucoma developed predominantly when cataract extraction was performed during the first week of life.