Purchase this article with an account.
S.S. Vismara, P. Dureau, C. Edelson, F. Metge, P. De Laage De Meux, G. Caputo; Congenital Cataract Surgery With Foldable Intraocular Lens In The First Year Of Life . Invest. Ophthalmol. Vis. Sci. 2006;47(13):715.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
In the last few years, congenital cataract surgery has evolved towards a certain degree of systematisation : Clear corneal incision, anterior and posterior capsulorhexis, anterior vitrectomy and IOL implantation in most cases. Many authors advocate foldable IOLs in this indication, but the age of one year sometimes remains a barrier for implantation. We retrospectively studied the infants operated with a foldable IOL in the first year of life from March 2003 to December 2004.
Thirty–four eyes of 24 patients were eligible for our study. IOL power was calculated by reducing the theoretical power (40% before 3 months, 35% from 3 to 6 months, 30% from 6 to 12 months), in order to anticipate the eye growth. For each eye, the following data were recorded: Age at the time of surgery, type of cataract, postoperative complications, necessity of a re–operation, final anatomical result, final refraction, follow–up.
Median age at the time of surgery was 4.6 months. The cataract was total in 7 eyes (20.5%), essentially in younger infants, nuclear and dense in 19 eyes (55.9%), zonular or posterior in 8 eyes (23.5%). A fibrinous reaction and/or anterior synechiae required a needle synechiolysis in 7 eyes (20.5%) (generally in younger infants and at the time of suture ablation). Five eyes (14.7%) showed a cellular proliferation in the visual axis for which an anterior vitrectomy was necessary. At final examination, the visual axis was clear in all eyes. The mean final refraction (SE) was +0.65 Dioptries (range: –5.5 to +6.5) while mean follow–up was 14.55 months.
The correction of aphakia in children is effective through IOL implantation. The use of foldable IOLs is possible in children younger than one year. A clear visual axis can be obtained in all cases and is a prerequisite to visual rehabilitation. When compared to PMMA IOLs, the procedure and postoperative period are generally simplified. The main obstacles remain the IOL power calculation, the placement of the lens (in the sulcus when the capsular bag is too small) and the more frequent postoperative inflammatory reaction requiring a re–operation in infants younger than six months. An aggressive postoperative treatment can limit these complications.
This PDF is available to Subscribers Only