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R. Markham, P. Gouws, H.M. Hussin; Congenital Cataract Surgery With Posterior Chamber Intraocular Lens Implantation in the First Year of Life – Long Term Outcomes . Invest. Ophthalmol. Vis. Sci. 2005;46(13):771.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To document the long–term outcome of congenital cataract surgery with posterior chamber lens implantation performed in the first year of life. Methods: A retrospective review of congenital cataract surgery in 8 infants with unilateral and 11 infants with bilateral cataract, with a mean follow–up of 77 months (range 52 – 123 months). Results: Mean age at surgery was 19.6 weeks (range 3 – 44 weeks) in the unilateral group, and 12.4 weeks (range 3 – 44 weeks) in the bilateral group. Best visual acuities were achieved in the bilateral group where 78% were 20/200 or better, and 28% were 20/40 or better (best 20/20). In the unilateral group, only 50% achieved 20/200 or better (best 20/60). Between first postoperative refraction and refraction at 36 months, there was a mean myopic shift of 3.6 dioptres (range +2.25 to –8.75) in the unilateral group, and 2.3 dioptres (range +3.50 to –4.75) in the bilateral group. As a group, eyes with unilateral cataract showed a greater myopic shift and ended up more myopic than eyes with bilateral cataract. The spread of final refractive error was wide and, in this group, was not closely related to age at surgery, initial axial length, or depth of amblyopia. Based on an 'A' constant of 119.0, the most appropriate IOL power for minimal final refractive error was +27.0D. Complications were opacification of the posterior capsule in most cases (simultaneous posterior capsulotomy was not carried out in this series), iris prolapse in two cases, and endophthalmitis with very poor visual outcome in one case (which was one of the iris prolapse cases). By the end of the follow–up period, one eye had ocular hypertension not requiring treatment, and one eye (with a family history of juvenile glaucoma)was under treatment for glaucoma. Conclusions: Intraocular lens implantation in infants of less than one year is a relatively safe procedure. It is associated with a reduced rate of glaucoma compared with lensectomy. Close suturing of all surgical entry sites to avoid iris prolapse is required. Visual outcomes in unilateral cataract were poor, partly related to failure to appreciate the importance of early clearance of posterior capsular opacity and the need for intensive occlusion therapy in this early series. An intraocular lens power of +27.0D in this age group gave the closest approximation to emmetropia at final follow–up.
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