Longitudinal study of endothelial cell density in aphakic children after congenital cataract extraction in infancy

Abstract

Purpose : To prospectively evaluate the endothelial cell density (ECD) in children who underwent surgery for congenital cataract in infancy.

Methods : This study included 28 pediatric patients who underwent surgery between August 2013 and July 2019. Patients with bilateral cataracts had one eye randomly selected for analysis. Pre-operative specular microscopy was performed in the lateral decubitus position under general anesthesia. Post-operative specular microscopy was performed during a clinical visit or under general anesthesia if required. Corneal diameter (CD) was measured under general anesthesia or in clinic. Results were compared with fellow eye (unilateral cataract) or with age-matched normative data (bilateral cataract).

Results : Twenty-eight eyes of 28 patients with congenital cataract extraction were included. Mean age at surgery was 2.7±2.1 months and at last follow-up 4.8±0.8 years. Five patients developed glaucoma at any time after surgery. There was a significant difference in endothelial cell loss and corneal diameter growth between those with and without glaucoma. There was no significant difference between unilateral and bilateral patients without glaucoma. As such, the glaucoma patients were not included in the analysis of the unilateral eyes and bilateral eyes vs. the fellow eye or age-matched normative data.

In unilateral eyes (9 patients) the mean pre-operative ECD (cells/mm2) was 4596±350 and CD was 10.8±0.5mm. The mean ECD at follow-up was 4167±458 and CD 11.6±0.6mm. In the fellow eye mean pre-operative ECD was 4512±328 and CD 11.1±0.5mm. Mean ECD at follow-up was 3724±176 and CD 12.1±0.7mm.

In bilateral eyes (14 patients) the mean pre-operative ECD was 4393±364 and CD 10.7±0.8mm. The mean ECD at follow-up was 4184±329 and CD 11.6±0.8mm. In the preoperative age-matched normative data (14 patients, age 0.3±0.2 years) the mean ECD was 4253±500 and CD 11.3±0.3mm. In the post-operative age-matched normative data (14 patients, age 4.8±0.8 years) mean ECD was 3711±165 and CD 12.2±0.4mm.

Conclusions : This is the first longitudinal study of ECD before and after congenital cataract surgery in infants. The ECD loss and CD growth in unilateral and bilateral aphakic patients were less than expected compared to the fellow eye or normative data respectively. We suspect this is due to the negative correlation between CD and ECD.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.