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B. K. Gangwani, G. Heidary, D. Vanderveen; Surgical and Visual Outcomes of Unilateral Cataracts in Infants. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5663.
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To determine etiology and evaluate the surgical and visual outcomes of unilateral cataracts in infants
All infants with unilateral infantile cataract operated on within the first year of life at Children’s Hospital Boston between 1991 and 2007 were identified. Preoperatively, etiology, presence of microcornea, strabismus and nystagmus was noted. Surgical technique included posterior capsulotomy and anterior vitrectomy, 4 eyes had primary intraocular lens implantation. Remaining patients were fitted with contact lenses at approximately 1 week after surgery, and a regimen of at least 50% of waking hours patching of the fellow eye was prescribed. Surgical outcome was assessed by presence of visual axis clarity and need of surgery for visual axis obscuration (VAO). Visual acuity in the operated and fellow normal eye at last follow-up visit was recorded. The occurrence of amblyopia, strabismus, nystagmus, and development of glaucoma or retinal detachment (RD) was noted.
56 infants (33 males, 23 females) with follow up >3 months were identified. Mean age at surgery was 12.6 weeks. 22 infants (39.3%) had persistent fetal vasculature (PFV), 1 had history of intraocular inflammation and in remaining cases, no cause could be ascertained. Preoperatively, 10(18%) had microcornea. Strabismus was present in 11(19.6%) prior to surgery, and present in all those who had measures of alignment > 6 months after surgery (49/49). 4 (7.1%) had nystagmus prior to surgery, and 13 (23.2%) showed nystagmus, including latent, when measured after surgery. Mean follow-up was 62 months (Range 3 to 166 months). 91% maintained visual axis clarity; only 5 (9%) eyes needed surgery for VAO. 3 had visual acuity ≥ 20/40, 19 had <20/40 to ≥20/150, 31 had ≤ 20/200 in the operated eye. Vision was only measured by fixation and followability in 3 infants. Poor vision was due to amblyopia in 48 (85.7%), but 3 PFV eyes became blind from RD. RD developed at 1 month after surgery in 2 eyes and after 2 years in one eye. 4 eyes (7.1%) had glaucoma, of which 3 developed within 4 months while 1 eye developed 9 years after surgery. Of 4 patients with glaucoma, 1 had microcornea and microphthalmos and 3 had PFV. All glaucoma patients were initially treated with topical drops; 2 required glaucoma surgery. No patients lost vision because of the glaucoma. 5 needed strabismus surgery.
Infants with unilateral cataracts have poor visual outcome despite a good surgical outcome owing to amblyopia, and virtually all develop strabismus. Most unilateral cataracts are idiopathic. PFV was identified as the second most common etiology and PFV is associated with increased risk of glaucoma and RD.
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