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mohamad tawfeek hakim, Adrien Coutu, hayat khan, patricio M. Aduriz-Lorenzo, abdullah al naqi, hachemi nezzar; Unilateral multifocal intra ocular lens implantation in pediatric cataract surgery: 5 years review.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5430.
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© ARVO (1962-2015); The Authors (2016-present)
In pediatric cataract surgery, there is no consensus on the utilization of multifocal intra-ocular lenses (IOL). The surgeons who are non-users of this IOL give several arguments like the risk of refraction modification after years due to myopisation phenomenon when children’s eyes grow. Users of it assert on the benefit of correcting not only the far vision but also the near one during critical amblyopiogenic years. The aim of this retrospective non-comparative study is to evaluate multifocal IOL implantation in children above 4 years old in terms of visual acuity and stereoptic vison outcome.
Between January 2010 and January 2015, 18 eyes of 18 children, aged between 4 and 16 years, were treated for unilateral cataract with a multifocal IOL. The follow-up was 1 to 5 years. Inclusion criteria were children with enough cooperation for accurate visual acuity, orthoptic examination and non-contact biometry. It excluded patients with corneal opacities or associated eye pathologies or previous eye surgeries. All patients had a lensectomy with posterior capsulotomy, and anterior vitrectomy with implantation of an apodized diffractive multifocal IOL in the bag. IOL power calculation used SRK/T formula and Surgery was performed by the same surgeon (HN). Refraction, visual acuity and stereoscopic vision using TNO test were evaluated during the follow-up period. Non-parametric Mann-Whitney test was used to compare visual acuities and stereoscopic visions.
Mean age of the children was 6 years and 4 months when the surgery was done. Mean visual acuity at the last evaluation was above 20/32 in 83% (15 eyes) of all patients, the best corrected distance visual acuity improved significantly (P <0.0001). The average follow-up was 38 (+/- 22) months. Refraction change occured in 22% of the patients (4 eyes), with an average of 0.75 diopters of myopisation [range 0.5-1.25]. Stereopsis improved significantly (p<0,0001) with an average of 55’’; 15 of our patients (83%) had a stereopsis better than 80”.
Considering multifocal IOL in children older than 4 years helps to improve the stereopsis and visual acuity. Indeed, it is known that the axial length of the eye will increase during the second decade of life within low grades. However, laser refractive surgery can help to correct the residual refractive error after the growth has completed.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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