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J.E. Anderson, S.M. Brown, W.A. Graham; Postoperative Astigmatism and Visual Acuity Following Implantation of Foldable Intraocular Lenses in Pediatric Patients . Invest. Ophthalmol. Vis. Sci. 2006;47(13):612.
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© ARVO (1962-2015); The Authors (2016-present)
To assess final astigmatism and visual acuity (VA) in children having cataract extraction with foldable intraocular lens (IOL) implantation through a securely sutured 4mm scleral tunnel incision.
A retrospective chart review of all pediatric patients undergoing cataract extraction with foldable IOL implantation in the practice of one surgeon from 2000 to 2002 was performed. The same technique was used in all cases. Incisions were closed with multiple non–absorbable sutures. Data regarding patient age, cataract etiology, fellow eye refraction, pre– and post–operative refractions, keratometry, and final visual acuity were collected.
Fourteen eyes of 12 children were included. Seven cataracts were traumatic (5 corneal or corneoscleral lacerations and 2 blunt injury), 5 were congenital, and 2 were uveitic secondary to juvenile rheumatoid arthritis with chronic steroid use. The mean follow–up for final postoperative refraction was 6.0 months (range 1.5 to 13 months). The mean preoperative cylinder was +2.05 D for all eyes in which it could be obtained (n = 8) and was +1.82 D excluding lacerations (n = 7); mean postoperative cylinder was +2.20 D for all eyes (n =14) and +2.00 D excluding lacerations (n = 9); mean fellow eye cylinder was +1.00 D for all eyes that had not undergone prior surgery (n = 11). For 12 eyes, it was possible to record a corrected Snellen visual acuity. For these eyes, the median corrected final visual acuity was 20/36; the mean corrected final visual acuity was 20/59 (range 20/20 to 20/200). Excluding eyes with visual acuity reduction secondary to confounding disease processes, the mean corrected final visual acuity of 9 subjects was 20/36 (range 20/20 to 20/64).
Placement of foldable IOLs in children through 4mm scleral tunnel incisions that are securely sutured does not induce significant permanent astigmatism. In eyes without confounding disease processes such as amblyopia or significant corneal irregularity due to traumatic scarring, the visual acuity outcome is generally good. Surgeons should not hesitate to securely suture scleral tunnel incisions in the elastic pediatric eye.
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