Change in Astigmatism After Sutured Clear Corneal Cataract Extraction in the Pediatric Population

Abstract

Purpose:: Corneal astigmatism following cataract surgery can be affected by the type, location, and closure of the corneal incision. In the pediatric population, clear corneal wounds are usually sutured. Postoperative astigmatism is of concern in children, as astigmatic anisometropia as low as 1.00 diopter may result in amblyopia. The purpose of this study was to evaluate the postoperative changes in astigmatism after cataract extraction in the pediatric population using sutured clear corneal temporal wounds and to assess whether the magnitude of postoperative astigmatism falls within the amblyogenic range.

Methods:: A retrospective chart review was performed on patients between the ages of 0-10 years old who had clear corneal cataract surgery with intraocular lens implantation. All corneal wounds were sutured with polyglactin 910 suture.

Results:: A total of 29 eyes of 21 patients who underwent clear corneal cataract surgery and intraocular lens implantation were included. The average patient age at surgery was 5.9 years with a range from 18 months to 10 years. 47% of the cataracts were congenital and 53% acquired. Mean astigmatism ± standard deviation one day postoperatively was 2.42 ± 1.26 diopters (D). Mean postoperative astigmatism decreased to 1.38 ± 0.80 D at week 1 and was 1.93 ± 0.98 diopters at month 1. The decrease in astigmatism from postoperative day 1 to postoperative month 1 was statistically significant (P=0.026). At postoperative months 2-4, the mean astigmatism was 1.65 ± 0.86 D, which was a statistically significant change from postoperative month 1 (P=0.004).

Conclusions:: Significant change in astigmatism can occur in the pediatric population with sutured clear corneal wounds during the first postoperative month. Since glasses are traditionally prescribed at one month after surgery, consideration may be given to correcting refractive error earlier postoperatively and reassessing refraction around 2 to 4 months to ensure optimal correction of refractive error in the amblyopic age range. The amount of postoperative astigmatism in children may be amblyogenic and requires close follow-up after pediatric cataract surgery.

Keywords: cataract • astigmatism • amblyopia