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G. Heidary, R. Krishnamurthy, D. VanderVeen; Prevalence and Course of Strabismus in Patients After Congenital Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4863.
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Ocular misalignment may be associated with the development of amblyopia, and is one aspect of ocular cosmesis that concerns patients and parents. Strabismus is common in patients who have had visually significant infantile cataracts. The aim of this study is to report on the prevalence, characteristics, and interventions for strabismus in a large cohort of children who underwent surgery for cataracts during the first year of life.
We performed a retrospective chart review for all patients at Children’s Hospital Boston who underwent cataract surgery at 12 months or younger between January 1991 and December 2005. Approval was obtained from the Human Subjects Committee for this study. Patients were excluded for follow-up less than 6 months. Data including onset, prevalence, direction, frequency, surgical treatments, and the presence of amblyopia were recorded.
Of the 98 patients whom we identified, complete data were available for 85 patients. Of these, 45 patients had bilateral cataracts and 40 patients had unilateral cataracts. Median follow-up from the time of the cataract surgery was 48 months (range 6.5 to 177 months) for patients with bilateral cataracts and 65 months (range 7 to 163 months) for patients with unilateral cataracts. During the entire follow-up period, 28/45 patients (62%) with bilateral cataracts showed strabismus, and 36/40 (90%) of patients with unilateral cataracts showed strabismus. The predominant direction of deviation was esotropic, which was seen in 25/36 (69%) strabismic unilateral patients and 22/28 (79%) strabismic bilateral patients. The strabismus was more likely to be constant in unilateral patients (23/36, 56%) than in bilateral patients (12/28, 43%). Surgical intervention occurred in 4/25 (16%) of the bilateral and 5/32 (15.6%) of the unilateral patients.
Strabismus is highly prevalent in children who require cataract aspiration in the first year of life, particularly in patients with unilateral congenital cataracts. Many of the patients in this cohort had small angle or intermittent deviations, so that surgical intervention was not indicated. The ophthalmic surgeon should recognize and educate parents that strabismus is a common association for these children, and address interventions such as amblyopia therapy and need for strabismus surgery as they arise.
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