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Madeleine Zetterberg, Gunilla Magnusson, Anne Petersen, Alf Nyström; Phacoemulsification and primary implantation with bag-in-the-lens IOL in paediatric cataract. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1986.
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© 2017 Association for Research in Vision and Ophthalmology.
To describe a paediatric cohort surgically treated for cataract with phacoemulsification and primary implantation with bag-in-the-lens intraocular lens (BIL-IOL) with regard to intra- and postoperative complications as well as visual outcome.
The study included 109 eyes of 84 children younger than 16 years of age having cataract surgery with phacoemulsification and primary implantation with BIL-IOL during 2009 through 2013. Exclusion criteria were uveitis or ≤6 months of follow-up. Medical records were retrospectively reviewed for systemic or ocular comorbidity, intra- or postoperative complications and visual outcome.
For all eyes, median age at surgery was 2.5 years (range 2 weeks - 14.1 years) with 26.6% being ≤12 weeks of age. The male:female ratio was 1:1. Of the included 84 children, 40 had unilateral cataract. Median follow-up time after initial surgery was 2.8 years (range 7 months - 5.8 years). During the follow-up period, 15 eyes (13.8%) developed glaucoma. For eyes having surgery during the first 12 weeks of age, the proportion of eyes developing glaucoma was 48.3% (n=14). The time interval between cataract surgery and glaucoma diagnosis was 15±8.4 weeks (mean±SD). In the entire cohort, 16 eyes (14.7%) had ocular comorbidity such as persistent foetal vasculature (PFV), embryotaxon, haemangioma at upper eye lid or ectropion uvea, at the time of surgery. The proportion of eyes developing glaucoma among those with ocular comorbidity was 60.0% as compared to 7.4% for those without ocular comorbidity (p<0.0001). For the entire cohort, only 5 eyes (4.6%) required treatment for visual axis opacification (VAO). Corrected distance visual acuity (CDVA) at last follow-up was 0.515±0.48 (logMAR; mean±SD) with 50 eyes (48.5%) attaining a CDVA of ≥0.5 (dec). For eyes with unilateral cataract the corresponding number was 0.667±0.51 with 37.5% attaining a CDVA of ≥0.5 and for bilateral cataracts CDVA was 0.418±0.45 with 55.6% attaining a CDVA of ≥0.5.
For children having cataract surgery with primary implantation of BIL-IOL, the risk of developing glaucoma is dramatically increased if surgery is performed during the first three months and in eyes with ocular comorbidity. VAO is rare in paediatric cataracts receiving BIL-IOL. Visual outcome was overall good with significantly better CDVA in eyes with bilateral cataract.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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